• Title/Summary/Keyword: Hemorrhagic

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Clopidogrel Response Variability in Unruptured Intracranial Aneurysm Patients Treated with Stent-Assisted Endovascular Coil Embolization : Is Follow-Up Clopidogrel Response Test Necessary?

  • Kim, Min Soo;Park, Eun Suk;Park, Jun Bum;Lyo, In Uk;Sim, Hong Bo;Kwon, Soon Chan
    • Journal of Korean Neurosurgical Society
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    • v.61 no.2
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    • pp.201-211
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    • 2018
  • Objective : The purpose of this study was to analyze the variability of clopidogrel responses according to duration of a clopidogrel drug regimen after stent-assisted coil embolization (SAC), and to determine the correlation between the variability of clopidogrel responses and thromboembolic or hemorrhagic complications. Methods : A total of 47 patients who underwent SAC procedures to treat unruptured intracranial aneurysms were enrolled in the study. Preoperatively, patients received more than seven days of aspirin (100 mg) and clopidogrel (75 mg), daily. P2Y12 reaction unit (PRU) was checked with the VerifyNow test one day before the procedure (pre-PRU) and one month after the procedure (post-PRU). PRU variability was calculated as the difference between the initial response and the follow-up response. Patients were sorted into two groups based on their response to treatment : responsive and hypo-responsive. Results : PRU variability was significantly greater in the hypo-responsive group when compared to the responsive group (p=0.019). Pre-PRU and serum platelets counts were significantly correlated with PRU variation (p=0.005 and p=0.004, respectively). Although thromboembolic complication had no significant correlated factors, hemorrhagic complication was correlated with pre-PRU (p=0.033). Conclusion : In conclusion, variability of clopidogrel responses during clopidogrel medication was correlated to serum platelet counts and the initial clopidogrel response. Thromboembolic and hemorrhagic complications did not show correlation with the variability of clopidogrel response, or the clopidogrel response after one month of medication; however, hemorrhagic complication was associated with initial clopidogrel response. Therefore, it is recommended to test patients for an initial clopidogrel response only, as further tests would be insignificant.

Hemorrhagic Bullous Lesions in a 9-year-old Girl with Henoch-Sch$\ddot{o}$lein Purpura (Henoch-Sc$\ddot{o}$lein 자반증에서 출혈성 물집을 동반한 9세 소아 1례)

  • Kim, Moon-Kyu;Park, Sung-Eun;Lee, Jun-Ho
    • Childhood Kidney Diseases
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    • v.16 no.1
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    • pp.51-53
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    • 2012
  • Henoch-Sch$\ddot{o}$nlein purpura (HSP) is the most common vasculitis in children and is characterized by cutaneous purpura, arthritis, abdominal pain, and nephritis. Bullous skin lesions are rare in children. We report a case involving a 9-year-old female with HSP who displayed rapidly evolving hemorrhagic bullae from the primary purpuric lesions during systemic corticosteroid therapy. The bullae disappeared within 7 days of systemic corticosteroid therapy. Some scar lesions of the skin developed on acute phase recovered completely after 6 months. Bullae should not be considered as a poor prognostic factor of HSP and its renal outcome. Skin biopsy in HSP children with bullae is not necessary if clinical diagnostic criteria of HSP are met. However, further evaluation of more pediatric HSP with bullae is needed to get the clearer conclusions. We report a 9-year-old female with HSP who showed the rapidly evolving hemorrhagic bullae from primary purpuric lesions during systemic corticosteroid therapy.

The Case-Control Study on Complete Blood Count as a Risk Factor of Stroke (뇌졸중 위험지표로서의 일반혈액검사 소견에 대한 환자;대조군 연구)

  • Lee, Hyon-Ui;Kang, Kyung-Won;Yu, Byeong-Chan;Bang, Ok-Sun;Baek, Kyung-Min;Seol, In-Chan;Kim, Yoon-Sik
    • The Journal of Internal Korean Medicine
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    • v.28 no.4
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    • pp.872-885
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    • 2007
  • Objective : Stroke is one of the most common causes of death in Korea. This study was done to evaluate the association of complete blood count (CBC) with the risk of hemorrhagic stroke and ischemic stroke. Methods : In 217-case patients with ischemic stroke or hemorrhagic stroke and 146 healthy control subjects without stroke, hypertension, diabetes mellitus, hyperlipidemia, or ischemic heart disease and 160 controls without ischemic stroke or hemorrhagic stroke, we tested and compared white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hgb), hematocrit (Hct) and platelet. These data were statically analyzed by general linear models and binary logistic regression analysis to get each adjusted odds ratio. Results :The level of WBC was significantly higher in all cases. The level of RBC, Hct and Hgb was significantly lower in patients of ischemic stroke. The level of platelet was significantly higher in patients of ischemic stroke. Conclusion : These results suggest high WBC may be a risk factor of hemorrhagic stroke and ischemic stroke and low RBC, low Hct, low Hgb and high platelet may be risk factors of ischemic stroke in Koreans.

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Diagnosis Case of Viral Hemorrhagic Septicemia (VHS) in Adult Olive Flounder Paralichthys olivaceus (넙치(Paralichthys olivaceus) 성어의 viral hemorrhagic septicemia (VHS) 진단사례)

  • Kim, In-Woo;Cho, Mi Young;Lee, Han-Na;Han, Hyun Ja;Oh, Yun Kyeong;Lee, Soon Jeong;Jee, Bo Young;Myeong, Jeong-In;Won, Kyoung-Mi
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.45 no.6
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    • pp.666-674
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    • 2012
  • We examined the cause of a disease outbreak in adult olive flounder Paralichthys olivaceus, which occurred at a Korean aquaculture farm in Korea in 2011. The principal signs included an expanded abdomen and congested liver, with persistent mortality (a little over two months). At the beginning of the outbreak, farm administrators misjudged the disease as bacterial in origin, because of the aforementioned signs, persistent mortality, and the detection of bacterial species, including Vibrio spp. and Streptococcus spp. Moreover, the detection of viral hemorrhagic septicemia virus (VHSV) by reverse trasnscription-PCR analysis was complicated by use of the VHS-VN primer set, which has been in general use recently, because it produced weak bands in some samples. Therefore, we recommend the use of at least two different primer sets in the diagnosis of VHSV. Our histopathological findings indicate that necrotizing myocarditis could be considered a pathogenic sign of VHSV infection.

Validity of Transfusing Group O+ Unmatched Packed Red Blood Cells in Hemorrhagic Shock Patients (출혈성 쇼크 환자에서 비교차시험 O+형 혈액 수혈의 유용성)

  • Lee, Ji-hwan;Choa, Minhong;Cho, Junho;Chung, Sung Pil
    • Journal of Trauma and Injury
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    • v.22 no.2
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    • pp.167-171
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    • 2009
  • Purpose: It is important to begin a transfusion safely and appropriately as soon as possible in a hemorrhagic shock patient. A group $O^+$ unmatched pack red blood cell (universal $O^+$) transfusion may satisfy that requirement. We report our experiences with universal $O^+$ to compare its usefulness for hemorrhagic shock patients with that of a matched pack red blood cell transfusion in the emergency department (ED). Methods: This is a retrospective study. Patients who had systolic blood pressure of less than 90 mmHg or a pulse rate of more than 120 beats per minute in the ED were included, and their medical records were reviewed. The collected data were demographic data, vital signs, blood test results, time to transfusion, the amount of transfusion, complications, and diagnoses. We calculated the emergency transfusion score (ETS) based on the patients' medical records. Results: Two hundred thirty-five patients were included. Forty-eight patients (36 trauma and 12 non-trauma patients) were transfused with a universal $O^+$. These patients had less time to transfusion compared with the cross-matched transfusion groups (35${\pm}$42 versus $170{\pm}187$ minutes, p<0.001). There were no differences in complications between groups (p=0.076). Of the patients who were transfused with universal $O^+$, 94.4% got more than 3 ETS. Conclusion: The universal $O^+$ transfusion, compared with matched pack red blood cell transfusion, should be a useful treatment for ED hemorrhagic shock patient due to its having a shorter time to transfusion without an increase in complications.

Thyroid Hormones and Thyroid Function status in each clinical phase of Korean Hemorrhagic Fever (한국형 출혈열의 임상경과에 따른 갑상선홀몬의 변동)

  • Shin, Young-Tai;Jeon, Byung-Sook;Yoon, Sung-Yeul;Lee, Houn-Young;Kim, Sam-Yong;Ro, Heung-Kyu
    • The Korean Journal of Nuclear Medicine
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    • v.17 no.1
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    • pp.63-69
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    • 1983
  • Fifteen cases of Korean hemorrhagic fever who were admitted Chungnam National University Hospital from October 1981 to December 1981 were analysed on the evaluation of metabolic.changes of the thyroid hormones, and thyroid function status in each clinical phase. 1. Serum $T_3,\;T_4$ concentratron, $FT_4I\;and\;T_4/TBG$ ratio were significantly lower (p<0.001, p<0.005, p<0.005, p<0.001, respectively) than control group in oliguric and early diuretic phase of Korean hemorrhagic fever. With the recovery of illness, abnormal thyroid hormones and thyroid function indices tend to become normal range. But Serum $FT_4$, TSH and TBG concentration were within normal range in all phase of KHF. Thus in Korean hemorrhagic fever, euthyroidism is probably maintained by normal or elevated serum $FT_4$ 2. $T_4/T_3\;and\;rT_3/T_3$ rato (p<0.005, p<0.005) were increased in oliguric and early diuretic phase of KHF. These results might be explained by decreased peripheral conversion of $T_4\;to\;T_3$ in oliguric and early diuretic phase.

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Clinical Analysis of Stroke in Young Adults (청장년층 뇌졸중에 대한 고찰)

  • 정은정;배형섭;문상관;고창남;조기호;김영석;이경섭
    • The Journal of Korean Medicine
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    • v.21 no.1
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    • pp.84-90
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    • 2000
  • Background and Purpose: Stroke in young adults is relatively uncommon. Only 3.7-14.4% of all strokes occur in patients aged 15-45 years. Stroke in young adults has more various and diverse possible causes than stroke in the elderly. We studied to gain further insight into both pathogenic and etiologic determinants in young adults with stroke. Methods : We retrospectively reviewed the medical records of 230 young patients aged 15-45 years who were admitted to the 2nd internal medicine department of Kyung Hee Oriental Medical Center with a diagnosis of stroke between May 1995 and May 1999. We analysed clinical features and diagnostic tests, such as brain imaging, cerebral angiography, echocardiography, 24 hours holter monitoring and other laboratory tests. Results : 1. Of 230 young patients with stroke aged 15-45 years(176 males(76.5%) and 54 females(23.5%)), 140 patients(60.9%) showed ischemic stroke and 90 patients(39.1 %) showed hemorragic stroke. 2. The most prevalent age group was from 40 to 45 years with 142 patients(61.7%) 3. The most frequent site of 140 ischemic stroke was MCA territory in 93 cases(66.4%) and Multiple, VA territory, PCA territory, ACA territory in order of frequency. 4. The most frequent site of 90 hemorrhagic stroke was basal galglia hemorrhage 57 cases(63.3%) and subcortical 13 cases(14.5%), pons, thalmus, subarachnoid, cerebellum in order of frequency. 5. The causes of hemorrhagic stroke were hypertension 49 cases(54.5%), arteriovenous malformation 7 cases(7.8%), ruptured aneurysm 4 cases(4.5%), angioma 3 cases(3.3%). 6. The risk factors of ischemic stroke were smoking, alcohol drinking, hyperlipidemia, hypertension, obesity, heart disease, history of CVA, diabetes mellitus, in order of frequency. 7. The comparison of risk factors between ischemic and hemorrhagic stroke: hypertension was prevalent in hemorrhagic stroke, heart disease and history of CVA were prevalent in ischemic stroke. Conclusions: From the above results, we found that stroke in young adults had various possible causes. Young adults with stroke deserve an extensive but tailored evaluation which include angiography and echocardiography for diagnosis.

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Brain Injuries during Intraoperative Ventriculostomy in the Aneurysmal Subarachnoid Hemorrhage Patients

  • Moon, Hyung-Ho;Kim, Jae-Hoon;Kang, Hee-In;Moon, Byung-Gwan;Lee, Seung-Jin;Kim, Joo-Seung
    • Journal of Korean Neurosurgical Society
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    • v.46 no.3
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    • pp.215-220
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    • 2009
  • Objective : Intraoperative ventriculostomy is widely adopted to make the slack brain. However, there are few reports about hemorrhagic or parenchymal injuries after ventriculostomy. We tried to analyze and investigate the incidence of these complications in a consecutive series of patients with aneurysmal subarachnoid hemorrhage (SAH). Methods : From September 2006 to June 2007, 43 patients underwent surgical clipping for aneurysmal SAH at our hospital. Among 43 patients, we investigated hemorrhagic or parenchymal injuries after intraoperative ventriculostomy using postoperative computed tomographic scan in 26 patients. After standard pterional craniotomy, ventriculostomy catheter was inserted perpendicular to the cortical surface along the bisectional imaginary line from Paine's point. Results : Hemorrhagic injuries were detected in 12 of 26 patients (46.2%). Mean systolic blood pressure during anesthesia was with in statistically significant parameter related to hemorrhage (p=0.006). On the other hand, parenchymal injuries were detected in 11 of 26 patients (42.3%). Female and the amount of infused mannitol during anesthesia showed statistically significant parameters related to parenchymal injury (p=0.005, 0.04, respectively). However, there were no ventriculostomy-related severe complications. Conclusion : In our series, hemorrhagic or parenchymal injuries after intraoperative ventriculostomy occurred more commonly than previously reported series in aneurysmal SAH patients. Although the clinical outcomes of complications are generally favorable, neurosurgeon must keep in mind the frequent occurrence of brain injury after intraoperative ventriculostomy in the acute stage of aneurysmal SAH.

Propensity score matching analysis on inpatient period differences of hemorrhagic stroke survivors depending on medical insurance coverage

  • Kim, Sang-Mi;Kim, Young;Lee, Seong-A
    • Physical Therapy Rehabilitation Science
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    • v.8 no.2
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    • pp.67-73
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    • 2019
  • Objective: The purpose of this study was to compare the differences in the length of hospital stay between hemorrhage stroke survivors with health insurance and those with medical care after controlling all factors except for the type of medical insurance by using the propensity score matching (PSM) method. Design: Retrospective cohort study. Methods: Data from the Korean National Centers for Disease Control and Prevention's In-Depth Discharge Injury Survey between the years 2006 and 2012 were used for analysis. A total of 4,538 cases were defined as persons with hemorrhagic stroke (I60-I62) based on the block of categories in the International Classification of Diseases (10th). In order to analyze the inpatient period differences depending on the type of health care, which reflects one's socio-economic level, the chi-square and t-test was conducted. Results: Frequency and percentage were presented, and regression analysis was used to determine the factors affecting the inpatient period. Age, severity of disease, treatment outcome, and post-discharge status were no longer statistically significant after matching. The inpatient period of the persons receiving medical aid benefits was found to be significantly longer than those with national health insurance (p<0.05). Conclusions: The factors influencing the inpatient period of hemorrhagic stroke survivors were treatment outcomes, severity of disease, hospital admission process, and the type of health care. It is necessary for systematic and comprehensive governmental management for persons with hemorrhagic stroke to be transferred to long-term care facilities.