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Background & Objective: EGB 761 is a standardized natural extract used to treat impaired cerebral perfusion and nutrition (cerebrovascular insufficiency) in Korea. Although several animal studies have been conducted, few studies have investigated the clinical effects of EGB 761 in acute stroke. This study assessed the clinical benefit of intravenous EGB 761 in patients with acute ischemic stroke. Methods: This retrospective study examined a prospectively collected stroke database. We evaluated 232 patients with acute ischemic stroke within 48 hours of symptom onset. All patients were treated with antiplatelet or anticoagulation agents. We compared baseline characteristics between the EGB 761-treated and non-treated groups. The functional outcome measure was the modified Rankin Scale (mRS) score 90 days after stroke onset. Results: Of the 232 patients, 170 received EGB 761 during the first 3 days after arrival in the emergency department. We found no significant differences in baseline characteristics between the groups, with the exception of atrial fibrillation (p=0.032). After adjusting for baseline factors, intravenous administration of EGB 761 was associated with an improved 90-day functional outcome (mRS ≤2) compared with the control group (odds ratio, 2.56; p<0.05). Conclusions: Our results showed a clinical benefit of intravenous EGB 761 in patients with acute ischemic stroke
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Accidente CerebrovascularRESUMEN
BACKGROUND AND PURPOSE: The Ankle-Brachial Index (ABI) is the ratio of blood pressure in the lower legs to that in the arms. The intima-media thickness (IMT) of extracranial carotid arteries determined by B-mode ultrasound is a measurable index of the presence of atherosclerosis. A low ABI and a high carotid IMT are independently related to increased risk of cardiovascular events. This study examined the association between carotid IMT and ABI in patients with ischemic stroke. MATERIALS AND METHODS: Retrospectively, 116 hospitalized patients with ischemic stroke were recruited. Using a pulse wave velocity ABI device along with carotid duplex sonography, we measured carotid IMT and ABI and investigated the correlation between average values. RESULTS: There was a significant difference in carotid IMT between the normal and abnormal ABI groups (P=0.0262). The group with an abnormal ABI was more than five times as likely to have increased carotid IMT as the group with a normal ABI (age, sex-adjusted OR 5.67 (95% CI 1.85~17.38)). The ABI and carotid IMT showed a weak inverse linear correlation in patients with ischemic stroke (correlation coefficient -0.378 after adjusting for age and sex). CONCLUSION: Our study suggests that an abnormal ABI is associated with a high carotid IMT in patients with ischemic stroke.
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Humanos , Índice Tobillo Braquial , Brazo , Aterosclerosis , Presión Sanguínea , Arterias Carótidas , Grosor Intima-Media Carotídeo , Pierna , Análisis de la Onda del Pulso , Estudios Retrospectivos , Accidente Cerebrovascular , UltrasonografíaRESUMEN
For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciego , Colonoscopios , Colonoscopía/instrumentación , Diseño de Equipo , Íleon , Intubación Gastrointestinal/instrumentación , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
No abstract available.
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Adulto , Humanos , Síndrome de Vaciamiento Rápido , Gastrostomía , Estado Vegetativo PersistenteRESUMEN
Cilostazol is a phosphodiesterase inhibitor that has been shown to have similar efficacy in stroke prevention but fewer hemorrhagic events compared with aspirin. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 67-year-old woman who has been treated with cilostazol for cerebral infarction. The patient was presented with sudden neck pain and right hemiparesis. Thirteen days after the onset, she recovered completely. Even cilostazol, which is a relatively safer drug in terms of bleeding risk compared to other antiplatelet agents, may cause SSEH. Therefore, physicians should keep in mind rare, but potentially fatal, bleeding complications such as SSEH when prescribing antiplatelet agents.
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Femenino , Humanos , Aspirina , Infarto Cerebral , Hematoma Espinal Epidural , Hemorragia , Dolor de Cuello , Paresia , Inhibidores de Agregación Plaquetaria , Accidente Cerebrovascular , TetrazolesRESUMEN
A severe, but reversible encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) was identified recently in young women with ovarian teratoma. This condition has not been reported previously in Korea. A 31-year-old woman presented with fever and behavioral disturbances; she became comatose several days later, and dyskinesia and dysautonomia developed thereafter. Antibodies to the NMDAR were positive and abdominal computed tomography detected a large ovarian teratoma. The patient improved dramatically after the removal of the teratoma and administration of corticosteroid therapy.
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Adulto , Femenino , Humanos , Encefalitis Antirreceptor N-Metil-D-Aspartato , Anticuerpos , Coma , Discinesias , Encefalitis , Fiebre , Corea (Geográfico) , N-Metilaspartato , Disautonomías Primarias , TeratomaRESUMEN
Listeria myelitis is known to be very rare and not reported yet in Korea. A 78-year-old man with diabetes mellitus and hepatocellular carcinoma presented altered mentality, paraparesis, and fever. His spinal cord MRI, cerebrospinal fluid study, and blood culture demonstrated thoracic myelitis caused by Listeria monocytogenes. This case suggests that listeria myelitis should be considered as one of the causes of non-tumorous myelopathy especially in immunocompromised patients.
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Anciano , Humanos , Carcinoma Hepatocelular , Diabetes Mellitus , Fiebre , Huésped Inmunocomprometido , Corea (Geográfico) , Listeria , Listeria monocytogenes , Mielitis , Paraparesia , Médula Espinal , Enfermedades de la Médula EspinalRESUMEN
This is the first case of virus-associated encephalitis/encephalopathy in which the pathogen was Hantaan virus. A 53-yr-old man presented fever, renal failure and a hemorrhagic tendency and he was diagnosed with hemorrhagic fever with renal failure syndrome (HFRS). In the course of his illness, mild neurologic symptoms such as dizziness and confusion developed and magnetic resonance images revealed a reversible lesion in the splenium of the corpus callosum. This case suggests that HFRS patients with neurologic symptoms like dizziness and mental slowing should be considered to have structural brain lesions and to require brain imaging studies.
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Humanos , Masculino , Persona de Mediana Edad , Anticuerpos Antivirales/sangre , Cuerpo Calloso/patología , Diagnóstico Diferencial , Virus Hantaan/inmunología , Fiebre Hemorrágica con Síndrome Renal/diagnóstico , Imagen por Resonancia Magnética , Recuento de Plaquetas , Diálisis RenalRESUMEN
Bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome has not been previously reported. Williams syndrome is a genetic disorder characterized by infantile hypercalcemia, elfi n facial features, an outgoing personality, and cardiovascular abnormalities. It has been found to be related to elastin gene defect. Cerebrovascular abnormalities with associated strokes in Williams syndrome have been described only recently and rarely. Moyamoya disease is a cerebrovascular disorder characterized by progressive occlusion of the supraclinoid internal carotid artery. The pathogenesis of Moyamoya disease is unclear. Only a single report of Moyamoya disease associated with Williams syndrome manifesting as an intracerebral hemorrhage has been published. We report the fi rst case of bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome. We propose that inherited moyamoya disease is also related to elastin gene defect.
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Itching is a rare symptom in neurological disease. Paroxysmal symptom is uncommon in neuromyelitis optica (NMO) or multiple sclerosis. We describe a 45-year-old woman who presented with paroxysmal pruritus in association with relapse of NMO on two separate occasions. Cervical MRI showed a lesion at a level corresponding to the dermatomal site of the itching. Paroxysmal pruritus could be a predictive symptom of relapse in NMO unless there are other comorbid causes such as systemic diseases, allergy, drug reaction, or emotional stress responsible for the itching.
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PURPOSE: Our objective was to analyze outcomes of treatment for open fractures of the tibia in children according to the classification of Gustilo-Anderson type. MATERIALS AND METHODS: We reviewed thirty five pediatric patients who underwent surgery for open fractures of the tibia between June 1998 and June 2007. We followed up over more than 1 year. Fractures were grouped into three types according to Gustilo-Anderson classification (Types I, II, and III). External fixation or flexible intramedullary nailing was used as the surgical method. We analyzed the period required to achieve radiologic bony union, tibial alignment, leg length discrepancy and complications. Clinical outcomes were assessed using the Karlstrom-Olerud method. RESULTS: Radiologically, bony union was achieved in 11.35+/-3.08 weeks, 10.50+/-2.20 weeks, and 21.62+/-7.19 weeks for types I, II, and III, respectively. Delayed union occurred in one case of type II and 3 cases of type III fractures. Complications such as nonunion, malunion and osteomyelitis were seen only in type III. Clinical outcomes showed excellent or good results in all cases except one (type III). CONCLUSION: Excellent outcomes for open fractures of the tibia in children can be obtained regardless of Gustilo-Anderson type when adequate procedures are performed.
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Niño , Humanos , Fijación Intramedular de Fracturas , Fracturas Abiertas , Pierna , Osteomielitis , TibiaRESUMEN
BACKGROUND: Prolotherapy is a therapeutic procedure used for chronic musculoskeletal and arthritic pain. It involves injecting an irritant solution to pain sites and causes patient discomfort, which can lead to treatment discontinuation. Remifentanil is an ultra short-acting micro-opiate receptor agonist that permits a rapid transition from intense analgesia to a minimal residual effect. Here, we evaluated the effect of remifentanil as a preparative medication for ambulatory prolotherapy. METHODS: Eighty patients taking prolotherapy were assigned into three groups for pre-therapeutic injections: remifentanil 0.1 microgram/kg/min alone (Group R), remifentanil 0.05 microgram/kg/min with midazolam 2 mg (Group M), and normal saline (Group C). Pain and sedation scores, blood pressure, pulse oxygen saturation, heart rate, satisfaction score, and time to discharge were measured. RESULTS: Pain scores in groups M and R were lower than group C during and after prolotherapy. The sedation score of group M was higher than groups R and C. Nine patients in group R experienced dizziness during prolotherapy. In group M, 8 patients experienced dizziness and 2 patients experienced nausea. There was no difference in time to discharge among all groups. Satisfaction scores in group M (7.3 +/- 0.8) and group R (7.0 +/- 0.8) were higher than that of group C (5.3 +/- 0.6). CONCLUSIONS: Remifentanil and remifentanil/midazolam effectively reduce the pain produced by prolotherapy.
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Humanos , Analgesia , Anestesia , Presión Sanguínea , Mareo , Frecuencia Cardíaca , Midazolam , Náusea , Pacientes Ambulatorios , Oxígeno , PiperidinasRESUMEN
PURPOSE: This study compares the mechanism of injury and the treatment outcomes in children and adults with Monteggia fractures. MATERIALS AND METHODS: 30 patients with Monteggia fractures were treated. There were 14 children with an average age of 8.6 years and 16 adults with an average age of 36.2 years. The results are based on a review of the clinical records and the initial radiographs combined with a follow-up examination. RESULTS: Pediatric Monteggia fractures were almost always found to be the result of low energy trauma (86%), but in adults, these fractures were most often found to be result of high energy trauma (88%). There were high prevalence of type III fractures with concomitant posterior interosseous nerve injury in the children. There were 7 serious complications in the adults. CONCLUSION: The clinical outcomes of Monteggia fracture in children were satisfactory as compared to that in adults. Yet, we recommend cautiously diagnosing and treating this injury in children because most type III fractures were accompanied by posterior interosseous nerve injury.
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Adulto , Niño , Humanos , Estudios de Seguimiento , Fractura de Monteggia , PrevalenciaRESUMEN
Actinomycosis is an indolent, slowly progressive infection caused by Actinomyces species and usually results in the formation of characteristic clumps called sulfur granules. Depending on the site of primary infection, it is generally classified as cervicofacial, thoracic, and abdominal type. Abdominal actinomycosis is often difficult to diagnose before operation because of its infrequent and chronic disease progression without any characteristic clinical features. In principle, diagnosis is based on histologic demonstration of sulfur granules in pus or surgically resected specimen, and the treatment consists of long-term antibiotic therapy coupled with or without surgical resection. We report a case of abdominal actinomycosis presenting as mesenteric mass adhering to small bowel confirmed by laparoscopic exploration and biopsy. Treatment with intravenous penicillin for 4 weeks followed by additional oral therapy for 11 months resulted in clinical resolution.
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Femenino , Humanos , Persona de Mediana Edad , Actinomicosis/diagnóstico , Antibacterianos/uso terapéutico , Mesenterio/patología , Penicilina G/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND/AIMS: Vascular access dysfunction is an important cause of morbidity and mortality in hemodialysis (HD) patients. Recent studies have shown that a klotho gene mutation is related to endothelial dysfunction, thrombosis, and arteriosclerosis, which are regarded as causes of vascular access dysfunction. We investigated the relationship between the klotho G-395A polymorphism and early dysfunction in vascular access in HD patients. METHODS: Patients who underwent vascular access operations between 1999 and 2002 were enrolled (n=126). Genotyping was performed by allelic discrimination using a 5'-nuclease polymerase chain reaction assay. Clinical data that could be relevant to access dysfunction were obtained from medical records. Early dysfunction of vascular access was defined as the need for any angioplastic or surgical intervention to correct or replace a poorly or nonfunctioning vascular access within 1 year and at least 8 weeks after initial access placement. RESULTS: Of the 126 patients, the genotype frequency of G-395A was 72.2% for GG (n=91), 24.6% for GA (n=31), and 3.2% for AA (n=4), and the frequency of minor allele was 0.155. Clinical data were similar between the two groups, divided according to the status of the A allele. Early dysfunction occurred in 34 (27.0%) of patients, but it occurred at a significantly higher rate in A allele carriers (45.7%, 16/35) than in noncarriers (19.8%, 18/91; p=0.003). CONCLUSIONS: Our results suggest that the klotho G-395A polymorphism could be a risk factor for early dysfunction of vascular access in HD patients.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación Arteriovenosa Quirúrgica , Catéteres de Permanencia , Estudios de Cohortes , Glucuronidasa/genética , Fallo Renal Crónico/complicaciones , Polimorfismo Genético/genética , Regiones Promotoras Genéticas/genética , Diálisis Renal , Enfermedades Vasculares/complicaciones , Grado de Desobstrucción Vascular/genéticaRESUMEN
BACKGROUND/AIMS: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. METHODS: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. RESULTS: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. CONCLUSIONS: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer.