Risk Factors of Unfavorable Outcomes, Major Bleeding, and All-Cause Mortality in Patients with Venous Thromboembolism

Purpose@#This study aimed to analyze the clinical outcomes of venous thromboembolism (VTE) patients and identify the risk factors for VTE-related unfavorable outcomes, major bleeding, and 30-day all-cause mortality. @*Materials and Methods@#From January 2016 to December 2020, 198 patients with confirmed VTE were enrolled. Potential risk factors for unfavorable outcomes, major bleeding, and all-cause mortality were analyzed. @*Results@#VTE-related unfavorable outcomes developed in 13.1%, while 30-day all-cause mortality was 8.6%. In the multivariate analysis, a pulse ≥110/min and respiratory rate ≥30/min were statistically significant predictors for VTE-related unfavorable outcomes. Diabetes was a significant risk factor for major bleeding. In addition, a history of malignancy, no anticoagulation treatment, and need for mechanical ventilation were significant predictors of all-cause mortality. @*Conclusion@#VTE-related mortality and morbidity rates remained high. In cases of tachycardia and tachypnea, early aggressive treatment is needed to prevent unfavorable outcomes. Patients with risk factors should be closely monitored.

Factors for Completing Case Management of Suicide Attempters: A Coihort Follow-Up Study Based on Data From Case Management of Emergency Room-Based Suicide Attempters / 정신신체의학

Objectives@#：The purpose of this study was to find out how demographic factors, suicide attempt patterns, psychiatric history and management of suicide attempters affect the completion of emergency department (ED) based case management program. @*Methods@#：Among the patients who attempted suicide and visited the emergency department of Chung-Ang University Hospital from June 1, 2018 to May 31, 2021, 661 patients who agreed to case management were studied. After being discharged from the emergency department, subjects were registered for an eight-week follow-up service program. Hierarchical logistic regression analysis was conducted with demographic factors, suicide attempt patterns, psychiatric history and management as independent variables, and completion of case program as dependent variables. @*Results@#：Suicide attempt pattern had the most significant influence on the completion of case management program, followed by demographic factors, psychiatric history and management. Those who completed the case management program were significantly more likely to have suicide plans in the future, more authentic in sui-cide attempts, and had higher proportion of past suicide attempts than those who did not complete the program. @*Conclusions@#：To ensure that the subjects complete the follow-up project program and get connected to community services, an individualized approach with consideration of suicide attempt patterns, demographic factors, and psychiatric history is needed.

Effect of Multidisciplinary Emergency Consultation System for Drug Intoxicated Patients / 정신신체의학

OBJECTIVES@#When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients.@*METHODS@#We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system.@*RESULTS@#After the ECS, admission to open wards was significantly higher than to the intensive care units (χ²=8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ²=4.202, p=0.053), and the time required for consultation response decreased (Z=−2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ²=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=−1.941, p=0.052).@*CONCLUSIONS@#After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs.

Relationship between physical factors and subjective image quality of cone-beam computed tomography images according to diagnostic task.

OBJECTIVE: This study was designed to investigate the relationship between physical factors and the subjective quality of cone beam computed tomography (CBCT) images used for different diagnostic tasks. STUDY DESIGN: CBCT images of a real skull phantom and a SedentexCT IQ phantom were acquired under different exposure conditions (one Dinnova3 CBCT scanner, 60-110 kV and 4-10 mA). Radiologists evaluated subjective image quality of real skull phantom images for each diagnostic task. On the basis of the evaluation results, the images were classified into two groups: acceptable and unacceptable. The modulation transfer function (MTF), contrast-to-noise ratio (CNR), and image uniformity were measured using the SedentexCT IQ phantom images. The differences in physical factors were evaluated. RESULTS: MTF and CNR values showed statistical differences in image quality in two groups with regard to all diagnostic tasks. In the maxilla, MTF and CNR values showed no significant differences between periapical diagnosis and implant planning in the acceptable groups. Higher MTF and CNR values were required in the periapical diagnosis compared with the implant planning of the mandible. CONCLUSIONS: This study proved that MTF and CNR values have a significant association with subjective image quality. The diagnostic task should be considered in evaluation of CBCT image quality.

Recurrent Transient Ischemic Attacks Caused by Postprandial Hypotension in a Patient with Occlusion of Right Internal Carotid Artery

We report a 72-year-old man suffering from recurrent attacks of transient drowsy mentality during meal or on orthostatic body position. Markedly disturbed collateral blood flow to right hemisphere was observed on conventional cerebral angiography. Acute and old ischemic lesions in the right internal borderzone area were also noticed on magnetic resonance image. Postprandial and orthostatic hypotension in the present case could be the cause of the recurrent neurological deficit developed in the primarily disturbed collaterals in the right middle cerebral territory.

Syndromic Diagnosis at the Epilepsy Clinic: Role of MRI / 대한간질학회지

PURPOSE: To evaluate the application of MRI to the ILAE classification of epilepsies and epileptic syndromes in the setting of epilepsy clinic. METHODS: We reviewed epilepsy registry forms, EEG, and MRI of 300 patients who were consecutively registered to the Yonsei Epilepsy Clinic. The algorhithm of syndromic classification consisted of 3 steps ; 1) clinical diagnosis based on the clinical informations described in the registry form, 2) clinical-EEG correlations, and 3) clinical-EEG-MRI correlations. The interictal epileptiform discharges (IEDs) in EEG were divided into focal, multilobar/multifocal, and generalized. MRI-lesions were divided into focal and non-focal (multilobar/multifocal, and diffuse) lesions. The clinical-EEG, EEG-MRI, and MRI-clinical correlations were categorized as concordant, not discordant, and discordant. RESULTS: Among 300 patients evaluated, 249 patients were found to have epilepsies and both EEG and MRI. By clinical analysis, 190 of 249 patients were diagnosed as localization-related epilepsies (LRE), 24 patients were generalized epilepsies (GE), 34 patients were undetermined epilepsies (UDE), and one patient had alcohol related epilepsy. EEG revealed IEDs in 124 patients and altered the clinical diagnosis in 79 patients. MRI lesions were found in 106 patients with focal lesions in 65 patients and non-focal lesions in 41 patients. MRI lesions were found in 47 of 125 patients with negative EEG. Concordance rates of clinical-EEG, EEG-MRI, and MRI-clinical correlations in 54 patients with lobar epilepsies, who had positive EEG and MRI, were 39%, 54%, and 52%, respectively, and discordant rates were 17%, 11% and 7%, respectively. The complete concordance of all 3 correlations was found in only 33% of them. In 20 patients diagnosed as GE by clinical-EEG correlations, MRI lesions were found in only 3 patients and none of them changed the diagnostic categories due to MRI lesions. CONCLUSION: In lobar epilepsies, the sensitivity of MRI was quite comparable with EEG and the clinical-MRI correlation was superior to the clinical-EEG correlations. MRI provided additional and complimentary informations and should be incorporated to the ILAE-classification system as the category of 'lesional epilepsy'.

Efficiency of Ultrasonography and CT Angiography in Follow-up Studies of Carotid Stent and Percutaneous Transluminal Angioplasty

PURPOSE: The aim of this study was to determine a more appropriate method for follow-up of carotid stenting by comparing the efficiency of US and CT angiography. MATERIALS AND METHODS: Eleven carotid arteries of seven patients(men: 5, women: 2, mean age: 56.4years) who underwent stent placement and percutaneous transluminal angioplasty(PTA) because of carotid stenosis were studied. The follow-up periods ranged from three to eleven(mean, five) months, and US and CT angiography were performed in one day. Color duplex sonography was performed with a 10 MHz linear array transducer. After spiral CT scan were obtained, MPR images were reconstructed on a workstation. Retrospective imaging analysis specifically focused on [1] stent configuration, [2] the accuracy of internal diameter measurement, [3] the detection of blood flow and the measurement of blood flow velocity, [4] the presence of atheroma and intraluminal thrombi, [5] the measurement of stent location, and [6] artifacts. RESULT: US was more accurate than CT angiography for measuring internal diameter. In all cases, US and CT angiography were able to detect the blood flow at carotid artery, and utilizing the Doppler spectrum, flow velocity was measured. US showed atheromas in all cases but CT angiography demonstrated calcified atheromas in three cases only. In six cases, US failed to determine stent location, though in this respect CT angiography was successful in all cases. Artifacts of US were small reverbe ration artifact(11/11) of the stent and a defective color Doppler signal caused by acoustic shadowing of atheroma calcification(3/11). Artifacts of CT angiogrpahy were hard-beam artifact of the stent(11/11) and motion artifact(3/11). CONCLUSION: US was superior to CT angiography in accuracy of measuring stent diameter, hemodynamic assessment, high-resolution views of the luminal state of the stent and minimal artifacts for the non-inva s i ve follow-up studies of carotid stenting.

Tarsal Tunnel Syndrome: Electrophysiological Study Using Interdigital Nerve Condition Test

BACKGROUND AND OBJECTIVES: Tarsal tunnel syndrome is a rare compressive neuropathy. Reported cases of the tarsal tunnel syndrome in Korea were diagnosed by conventional nerve conduction and EMG studies, so their sensitivity was low and the differentiation from similar disorder such as lumbosacral radiculopathy was difficult. We report the usefulness of the interdigital nerve conduction study by using needle recording electrodes in the tarsal tunnel syndrome. METHODS: Sensory compound nerve action potentials were recorded orthodromically using the near-nerve needle and signal averaging techniques. Active and reference recording electrodes were inserted behind the medial malleolus above the flexor retinaculum. When the great toe was contracting minimally with less than 3mA for a stimulus of 0.05ms duration, the needle was considered to be adequately positioned. The first and fifth digital nerves were stimulated with ring electrodes and various interdigital nerves with interdigital stimulating surface electrodes which were specially designed. Averaged sensory action potential were recorded 3 times and superimposed after 64 stimuli per each time of recording. Amplitude of sensory nerve action potential, sensory nerve conduction velocity, and the presence of the temporal dispersion were checked. The results were as follow, 1. The causes of the 775 were trauma in 3 cases, sprain in 2 cases, unknown in 5 cases. 2. Associated disease were radiculopathy in 6 cases, rheumatoid arthritis In 1 case, carpal tunnel syndrome In 1 case. 3. Clinical findings included pain on the in 5 cases, tingling sensation in 4 cases, hyperesthesia in 4 cases, numbness in 2 cases and Tinnel's sign in 2 4. Five cases showed absent potential, 5 cases low amplitude, 4 cases dispersion, 2 cases slow nerve conduction velocity and 2 cases low amplitude and slow nerve conduction velocity by Interdigital nerve condution study. 5. Five lumbosacral radiculopathy without tarsal tunnel syndrome showed normal results in interdigital nerve conduction test. We concluded that interdigital nerve conduction test using needle recording electrode is useful methods of diagnosing tarsal tunnel syndrome as well as differentiating to other disorders having similar symptoms.