Length of Hospital Stay After Stroke: A Korean Nationwide Study

OBJECTIVE: To investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service. METHODS: We matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex. RESULTS: The mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age. CONCLUSION: LOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.

Analysis of Sleep Questionnaires of Patients who Performed Overnight Polysomnography at the University Hospital / 결핵및호흡기질환

BACKGROUND: The objective of this study was to understand sleep-related problems, and to determine whether the sleep questionnaires is a clinically useful method in patients who need polysomnography. METHODS: Subjects were patients who performed polysomnography and who asked to answer a sleep questionnaires at the Sleep Disorders Clinic of St. Paul's Hospital, Catholic University of Korea. Baseline characteristics, past medical illness, behaviors during sleep-wake cycle, snoring, sleep-disordered breathing and symptoms of daytime sleepiness were analyzed to compare with data of polysomnography. RESULTS: The study population included 1081 patients(849 men, 232 female), and their mean age was 44.2+/-12.8 years. Among these patients, 38.9% had an apnea-hypopnea index(AHI) < 5, 27.9% had 5 < or = AHI < 20, 13.2% had 20 < or = AHI < 40, and 20.0% had 40 < or = AHI. The main problems for visiting our clinic were snoring(91.7%), sleep apnea(74.5%), excessive daytime sleepiness(8.0%), insomnia(4.3%), bruxism(1.1%) and attention deficit(0.5%). The mean value of frequency of interruptions of sleep was 1.6 and the most common reason was urination(46.3%). Epworth Sleepiness Scale(ESS) had a weak correlation with AHI(r=0.209, p<0.01). When we performed analysis of sleep questionnaires, there were significant differences in the mean values of AHI according to the severity of symptoms including snoring, daytime sleepiness, taking a nap and arousal state after wake(p<0.05). CONCLUSION: On the basis of statistical analysis of sleep questionnaires, the severity of subjective symptoms such as ESS, snoring, daytime sleepiness and arousal state after wake correlated with the AHI significantly. Therefore the sleep questionnaires can be useful instruments for prediction of the severity of sleep disorder, especially sleep-disordered breathing.

Analysis of Sleep Questionnaires of Patients who Performed Overnight Polysomnography at the University Hospital / 결핵및호흡기질환

BACKGROUND: The objective of this study was to understand sleep-related problems, and to determine whether the sleep questionnaires is a clinically useful method in patients who need polysomnography. METHODS: Subjects were patients who performed polysomnography and who asked to answer a sleep questionnaires at the Sleep Disorders Clinic of St. Paul's Hospital, Catholic University of Korea. Baseline characteristics, past medical illness, behaviors during sleep-wake cycle, snoring, sleep-disordered breathing and symptoms of daytime sleepiness were analyzed to compare with data of polysomnography. RESULTS: The study population included 1081 patients(849 men, 232 female), and their mean age was 44.2+/-12.8 years. Among these patients, 38.9% had an apnea-hypopnea index(AHI) < 5, 27.9% had 5 < or = AHI < 20, 13.2% had 20 < or = AHI < 40, and 20.0% had 40 < or = AHI. The main problems for visiting our clinic were snoring(91.7%), sleep apnea(74.5%), excessive daytime sleepiness(8.0%), insomnia(4.3%), bruxism(1.1%) and attention deficit(0.5%). The mean value of frequency of interruptions of sleep was 1.6 and the most common reason was urination(46.3%). Epworth Sleepiness Scale(ESS) had a weak correlation with AHI(r=0.209, p<0.01). When we performed analysis of sleep questionnaires, there were significant differences in the mean values of AHI according to the severity of symptoms including snoring, daytime sleepiness, taking a nap and arousal state after wake(p<0.05). CONCLUSION: On the basis of statistical analysis of sleep questionnaires, the severity of subjective symptoms such as ESS, snoring, daytime sleepiness and arousal state after wake correlated with the AHI significantly. Therefore the sleep questionnaires can be useful instruments for prediction of the severity of sleep disorder, especially sleep-disordered breathing.

A Fat Density Mass in the Mediastinum / 결핵및호흡기질환

A 47-year-old female was admitted for an evaluation of a left mediastinal mass. The chest X-ray performed 16 months ago was normal, but the chest X-ray upon admission showed a large mass adjacent to the anterior aspect of the left hemidiaphragm. The CT scan demonstrated a large mass with a fat density in the left lower hemithorax. A focal diaphragmatic defect behind the xiphoid process was suspected. A thoracoscopic examination revealed omental herniation through the diaphragmatic defect. Therefore, a left thoracotomy was performed and the defect was repaired. We believe that a differential diagnosis should be needed to include a diaphragmatic omental hernia when a fat density mass is observed in the mediastinum.

Paradoxical Upper Airway Obstruction and Central Sleep Apnea Developed After Anterior Cervical Spine Fusion / 결핵및호흡기질환

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.

Analysis of HLA in Patients with Obstructive Sleep Apnea Syndrome / 결핵및호흡기질환

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is believed to have multifactorial causes. The major risk factors for OSAS are obesity, narrowed upper airways, and abnormal cranial-facial structures. A genetic basis for OSAS has been also suggested by reports of families with many members affected. This study analyzed the HLA typing in patients with OSAS to determine the possible role of genetics in OSAS. METHODS: Twenty-five Korean patients with OSAS (1 woman and 24 men; age range 30-66 years) were enrolled in this study. A diagnosis of OSAS was made using full-night polysomnography. The control group consisted of 200 healthy Korean people. Serologic typing of the HLA-A and B alleles was performed in all patients using a standard lymphocyte microcytotoxicity test. Analysis of the polymorphic second exons of the HLA-DRB1 gene was performed using a polymerase chain reaction-sequence specific oligonucleotide probe. RESULTS: The allele frequency of HLA-A11 was significantly lower in patients with OSAS compared with the controls (p45) than in the controls (p<0.05). CONCLUSION: This study revealed an association between OSAS and the HLA-A11 and DRB1*09 alleles as well as association between the disease severity and the HLA-DRB1*08 allele in Korean patients. These results suggest that genetics plays an important role in both the development and the disease severity of OSAS.

An Endobronchial Fibroepithelial Polyp Treated by Bronchoscopic Excision / 결핵및호흡기질환

An 81-year-old man underwent bronchoscopy to investigate the cause of his dyspnea symptoms. A benign natured mass was observed in the bronchus and was excised. The pathology examination revealed a fibroepithelial polyp. He has been asymptomatic since the simple bronchoscopic excision. A fibroepithelial polyp is a benign tumor with a mesodermal origin. It is commonly found in the skin, urogenital area and chest, but is extremely rare in the respiratory system. We report a case of a fibroepithelial polyp in the bronchus, which was treated with a bronchoscopic excision, with a brief review of the relevant literature.

A Case of Pleural Aspergillosis / 결핵및호흡기질환

Aspergillus species cause a wide spectrum of diseases in humans and most frequent site of infection is lung. Pleural aspergillosis is a rare disease with only 3 cases having been in Korea. It may occur as a complication of tuberculosis, especially after pneumonectomy for this condition, or rupture of cavitary pulmonary aspergillosis into the pleura. We report a patient with pleural aspergillosis who showed a clinical improvement with antifungal therapy.

A Small Rectal Carcinoid Tumor with Liver Metastasis / 대한소화기내시경학회지

Carcinoid tumors are originated from the enterochromaffin cells in the gastrointestinal mucosa. The incidence of rectal carcinoid tumors is more than 10 percent of gastrointestinal tract carcinoid. The tumor has naturally the benign character that does not develop symptoms and it is found incidentally. The tumor may infrequently have a malignant behavior such as invasion to muscle wall, obstruction of bowel lumen and metastasis to distant organ (especially, liver) almost when its size is larger than 2 cm. We have experienced a case of rectal carcinoid tumor smaller than 1 cm in its size with huge metastatic mass of liver.

The Influences of Obstructive Apneas on Changes of Cardiovascular Function in Anesthetized Dogs with alpha-chloralose / 결핵

BACKGROUND: Patients with obstructive sleep apnea syndrome are known to have high long-term mortality compared to healthy subjects because of their cardiovascular dysfunction. The observation of hemodynamic changes by obstructive apneas is helpful to understand when attempting to understand the pathophysiological mechanism of the development of cardiovascular dysfunction in those patients. Therefore, we studied the changes of in cardiovascular function with the an animal model and tried to obtain the basic data for an ideal experimental model (this phrase is unclear), which is required a requirement for the a more advanced study. METHODS: In 16 Sixteen anesthetized dogs with alpha-chloralose, experimental subjects (delete) were divided into two groups : 8 dogs of room air breathing group and 8 dogs of oxygen breathing group. We measured PaO2, PaCO2, heart rate, cardiac output, mean femoral artery pressure, and mean pulmonary artery pressure at specified times during the apnea-breathing cycle : before endotracheal tube occlusion (baseline), 25 seconds after endotracheal tube occlusion (apneic period), 10 seconds (early phase of postapneic period, EPA) and 25 seconds (late phase of postapneic period, LPA) after spontaneous breathing. RESULTS: In room air breathing group, the heart rate significantly decreased significantly decreased at during the apneic period compared to that at baseline (P<0.01) and increased at EPA and LPA compared to that during the apneic period (P<0.01). But, the heart rate showed no significant changes during apneic and postapneic periods in the oxygen breathing group. Cardiac output tended to decrease at during apneic period compared to that at baseline, but did not show statistical significance was statistically significant. Cardiac output significantly decreased at LPA compared to at baseline (P<0.01). Mean femoral artery pressure was significantly decreased at during apneic period compared to that at baseline (P<0.05). CONCLUSION: Through this experiment, we were partially able to understand the changes of cardiovascular function indirectly, but it is suggested that the (delete) new experimental animal model displaying physiological mechanism close to sleep in nature might natural sleep should be established (,)and the advanced study of in the changes of cardiovascular function and its cause their causes should be continued.

Effects of CPAP Therapy on Systemic Blood Pressure, Cardiac Rhythm and Catecholamines Concentration in Patients with Obstructive Sleep Apnea / 결핵

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) affects systemic blood pressure and cardiac function. The development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac rhythm, suggests that recurrent hypoxia and arousals from sleep may increase a sympathetic nervous system activity. Continuous positive airway pressure(CPAP) therapy has been found to be an effective treatment of OSAS. However, only a few studies have investigated the cardiovascular and sympathetic effects of CPAP therapy. We evaluated influences of nasal CPAP therapy on the cardiovascular system and the sympathetic activity in patients with OSAS. METHODS: Thirteen patients with OSAS underwent CPAP therapy and were monitored using polysomnography, blood pressure, heart rate, presence of arrhythmia and the concentration of plasma catecholamines, before and with CPAP therapy. RESULTS: The apnea-hypopnea index (AHI) was significantly decreased (p<0.01) and the lowest arterial oxygen saturation level was elevated significantly after applying CPAP (p<0.01). Systolic blood pressure tended to decrease after CPAP but without statistical significance. Heart rates during sleep were not significantly different after CPAP. However, the frequency and number of types of arrhythmia decreased and sinus bradytachyarrhythmia disappeared after CPAP. Although there was no significantly decreased after CPAP (p<0.05). CONCLUSION: CPAP therapy decreased the apnea-hypopnea index, hypoxic episodes and plasma norepinephrine concentration. In addition, it decreased the incidence of arrhythmia and tended to decrease the systemic blood pressure. These results indicate that CPAP may play an important role in the prevention of cardiovascular complications in patients with OSAS.

Extensive Bilateral Airspace Consolidation / 결핵

Pneumonia caused by Mycoplasma pneumoniae is usually a mild and self-limited infection. Chest films usually show patch consolidation or interstitial infiltration in the lung. We recently encountered a case of fulminant Mycoplasma pneumonia which showed rapidly progressing extensive bilateral airspace consolidation with pleural effusion. A previously healthy 19-year-old female college student was admitted to the hospital because of fever and dry cough. Chest X-ray showed large areas of airspace consolidation in both lung with pleural effusion and rapid progression of the lung lesion. The diagnosis of Mycoplasma pneumonia was made from the serologic test. Here we report a case of Mycoplasma pneumonia showing unusual manifestation.

A Case of Alstrom Syndrome / 대한내분비학회지

The Alstrom syndrome is inherited autosomal recessive disorder, characterized by obesity, diabetes mellitus, pigmentary retinal degeneration, normal intelligence, sensorineural hearing loss, baldness, acanthosis nigricans, male hypogonadism, hyperuricemia and hypertriglyceridemia. There is no reported case of Alstrom syndrome in Korea yet. We experienced a 29-year-old female patient with clinical characteristics similar to Alstrom syndrome who was admitted due to poorly controlled diabetes mellitus and diabetic retinopathy with hemorrhage. We report this case with the review of literatures.

Risk Factors for Failed Healing in Amputation for Vacscular Obstructive Diseases in Lower Extremity / 대한정형외과학회잡지

We examined the factors which may serve as predictors of success or failure of amputation in lower extremity for vascular obstructive diseases in 52 consecutive patients who were treated at the Department of Orthopaedic Surgery and Yonsei Cardiovascular Center from January 1st, 1990 to December 31st, 1994. The minimum follow up period was 10 months. The population was divided into two groups, group of success of primary amputation and group of failure. The results were as follows, male and female ratio was 42:10 and the average age was 57.5 years old. Among total 52 cases, there were 22 cases of arteriosclerosis obliterans, 15 cases of Buerger's diseases, 12 cases of vasculitis, 3 cases of acute arterial embolism. Complications after primary amputation included 9 cases of superficial wound infections, 7 cases of marginal wound necroses. Sixteen cases belonged to the group in which reamputation were performed because of intractable poor wound healing. Preoperative value of hemoglobin, hematocrit, serum albumin and serum creatinine which had been generally known as prognostic factors in wound healing were not related to the necessity of reamputation (Multivariate Regression Test, P>0.05). And also age, blood pressure and smoking history and level of amputation didn't show any difference between two groups but existence of lower extremity infection and uncontrolled diabetes mellitus were related to the prognosis of reamputation (Multivariate Regression Test, P<0.05).

A Stainless Steel Foreign body in the Knee Joint With Synovitis: A Case Report / 대한정형외과학회잡지

A foreign body reaction to biodegradable fixation materials for internal fixation of a variety of fractures and osteotomies has been described since nineteen eighty five. Polyglycolide and other biodegradable poly-alpha-hydroxyacids such as polylactide (PLA) or polydioxanone (PDS) causes a non-specific inflammatory reaction with invasion of macrophages, multinucleated foreign body giant cells and neutrophilic polymorphonuclear leucocytes. The wood and needle fish were reported to cause foreign body reaction by several authors. But there is no report about aseptic synovitis caused by intraarticular stainless steel foreign body. So we report a case of aseptic synovitis reaction to stainless steel treated successfully by arthroscopic surgery and discuss the possible reasons for this inflammatory reaction.