• Title/Summary/Keyword: Stroke/diagnosis

Search Result 285, Processing Time 0.023 seconds

Clinical Course of Suspected Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy: A 10-Year Experience of Rapid Progressive Right Ventricular Failure Syndrome in Advanced Cancer Patients

  • Minjung Bak;Minyeong Kim;Boram Lee;Eun Kyoung Kim;Taek Kyu Park;Jeong Hoon Yang;Duk-Kyung Kim;Sung-A Chang
    • Korean Circulation Journal
    • /
    • v.53 no.3
    • /
    • pp.170-184
    • /
    • 2023
  • Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions: Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient's prognosis.

A Clinical Study on the Factors that Influence Functional Evaluation of Stroke (중풍의 기능평가에 영향을 미치는 요인에 관한 임상적 고찰)

  • 박숙자;권정남;김영균
    • The Journal of Korean Medicine
    • /
    • v.23 no.4
    • /
    • pp.73-90
    • /
    • 2002
  • Objectives: This study investigated significant factors that influence functional evaluation of stroke so as to be a fundamental data for estimating prognosis of stroke patients. Methods: 204 patients were studied within 7 days of admission, after the diagnosis of stroke through brain CT scan, brain MRI scan and clinical observations. They were hospitalized in the oriental medical hospital of Dongeui University from February to July in 2001. They were examined at the early stage of onset, after 2 weeks, 4 weeks and 6 weeks, and measured for average mark and the degree of improvement by using the Activity Index. Results: Ischemic stroke, past history of stroke, hypertension, diabetes mellitus, risk factor of obesity, non-professional emergency treatment and hospitalizing time after 1 day from onset, high blood pressure, tachycardia pulse and high blood sugar in abnormal vital sign in acute stage, conscious, cognitive or communication disorder, motor aphasia, dysphagia, constipation for more than 3 days, urinary incontinence, visual field defect, insomnia, and chest discomfort in early stage of onset had a negative influence on functional evaluation. Conclusions: Type of stroke, past history, risk factors, emergency treatment and hospitalizing time after onset, abnormal vital sign and intercurrent symptoms in Acute stage were relevant factors in predicting functional evaluation of stroke.

  • PDF

The Relationship between Pain and Quality of Life in Stroke Patients (뇌졸중 후 통증 발생과 삶의 질과의 관계)

  • Kwon, Mi-Ji
    • Journal of the Korean Society of Physical Medicine
    • /
    • v.12 no.2
    • /
    • pp.83-90
    • /
    • 2017
  • PURPOSE: Central post-stroke pain (CPSP), a chronic pain condition of stroke patients, can impair activities of daily living and worsen the quality of life (QOL), thereby negatively influencing the rehabilitation process. However, CPSP remains an underestimated complication of stroke. This study aimed to describe the prevalence and types of new-onset chronic pain and to identify the relation between pain and QOL in stroke patients. METHODS: All patients hospitalized because of a diagnosis of stroke were included. Questionnaire was used. Pain intensity was measured using Numerical rating scale (NRS), and pain characteristics were assessed using DN4. QOL was measured using SF-36. Descriptive statistics were used to analyze the characteristics and pain data, and chi-square test was used to compare QOL categorical data between the nociceptive and neurological pain groups. RESULTS: CPSP development was reported by 34% of the post-stroke pain patients. Perceived QOL was low in both groups, especially with respect to the physical functioning, bodily pain, physical-role functioning, emotional-role functioning, and mental health domains. However, no significant difference was observed in QOL between the nociceptive and neurological pain groups (p<.05). CONCLUSION: Our results indicated that CPSP is a common and disabling complication that is difficult to treat, often decreases QOL, and may negatively affect rehabilitation treatment.

A Literature Study on the Application of Sa-am Acupuncture for the Treatment of Stroke (중풍(中風)에 대한 사암침법(舍岩鍼法)의 운용(運用)에 관한 문헌(文獻) 연구 - ${\ll}$사암침구정전(舍岩鍼灸正傳)${\gg}$${\ll}$동의보감(東醫寶鑑)${\gg}$${\ll}$침구대성(鍼灸大成)${\gg}$과의 비교연구 -)

  • Lee, Jung-Tae;Yim, Yun-Kyoung
    • Journal of Acupuncture Research
    • /
    • v.23 no.5
    • /
    • pp.115-125
    • /
    • 2006
  • Objectives & methods : This study aimed to investigate and compare the traditional acupuncture treatment and Sa-am acupuncture treatment of stroke. We investigated ${\ll}$Sa-am chimgujeongjeon(舍岩鍼灸正傳)${\gg}$ for Sa-am acupuncture treatment, and ${\ll}$Dongeuibogam(東醫寶鑑)${\gg}$ and ${\ll}$Chimgudaesung (鍼灸大成)${\gg}$ for traditional acupuncture treatment. Results & Conclusion : 1. In the traditional acupuncture treatment, acupoints on CV, GV, GB, LI, ST meridians to remove pathogens such as fire, damp, phlegm, blood stagnation and Ashi points (nearby points) are often used rather than acupoints according to the diagnosis of excess & deficiency in organs and meridians. 2. In ${\ll}$Sa-am chimgujungjeon(舍岩鍼灸正傳)${\gg}$, symptoms of stroke are classified into 21 and each symptoms are analyzed according to the diagnosis of excess & deficiency of organs and meridians, consequently treated using tonification & sedation of corresponding meridians. 3. For the treatment of stroke in ${\ll}$Sa-am chimgujungjeon(舍岩鍼灸正傳)${\gg}$, tonification & sedation of the acupoints on related meridian is often omitted, using only the acupoints on targeted meridian. 4. In ${\ll}$Sa-am chimgujungjeon(舍岩鍼灸正傳)${\gg}$, empirical points are preferably used for the treatment of stroke.

  • PDF

Study II of Diagnosis Criteria for Qi deficiency in Stroke (중풍 기허증 진단 기준에 관한 연구 II)

  • Kang, Byoung Kab;Heo, Tae Young;Yun, Kyung Jin;Park, Tae Yong;Lee, Ju Ah;You, Soo Seong;Park, Geon Hee;Lee, Myeong Soo
    • Journal of Physiology & Pathology in Korean Medicine
    • /
    • v.28 no.1
    • /
    • pp.76-81
    • /
    • 2014
  • The aim of this study was to build the diagnosis criteria of Qi deficiency using distribution of sum of 11 items for Qi deficiency in stroke patients. Between September 2006 and December 2010, 2,994 patients from 11 Korean medical hospitals were asked to complete the Korean Standard Pattern Identification for Stroke (K-SPI-Stroke) questionnaire as a part of project 'Fundamental study for the standardization and objectification of pattern identification in traditional Korean medicine for stroke (SOPI-Stroke). Each patient was independently diagnosed by two experts (traditional Korean medicine physicians) from the same site according to one of five patterns. 2,994 patients were divided modeling and testing in 70:30 ratio by stratification of pattern identification. We calculated the sensitivity, specificity, accuracy and odds ratio (OR) using distribution of sum of 11 items (signs and symptoms) for Qi deficiency. More than four from 11 items of Qi deficiency in modeling dataset, sensitivity, specificity, accuracy and OR was 70.07%, 74.94%, 73.92% and 7.00, respectively. In testing dataset, 78.31%, 73.45%, 74.47% and 9.98, respectively. Although this values are not high, after values of sensitivity, specificity, accuracy and OR should be more than current value, and then we should be able to suggest as objective diagnosing criteria.

Clinical features and risk factors for missed stroke team activation in cases of acute ischemic stroke in the emergency department

  • Byun, Young-Hoon;Hong, Sung-Youp;Woo, Seon-Hee;Kim, Hyun-Jeong;Jeong, Si-Kyoung
    • Journal of The Korean Society of Emergency Medicine
    • /
    • v.29 no.5
    • /
    • pp.437-448
    • /
    • 2018
  • Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

The discrimination model for the pattern identification diagnosis of the stroke (중풍의 변증 진단을 위한 판별모형)

  • Kang, Byeong-Kab;Kang, Kyung-Won;Park, Sae-Wook;Kim, Bo-Young;Kim, Jeong-Chul;Go, Mi-Mi;Seol, In-Chan;Jo, Hyun-Kyung;Lee, In;Choi, Sun-Mi
    • Korean Journal of Oriental Medicine
    • /
    • v.13 no.2 s.20
    • /
    • pp.59-63
    • /
    • 2007
  • The purpose of this study was to diagnosis that what patterns identification using the statistical method. Discriminant analysis using the medical specialist and resident pattern identification agree case in stroke patients within 1 month of onset. The agreement rate of dificiency of Gi(75%), heat-transformation(74%), dampphlegm syndrome(69%), deficiency of Eum(51%) and syndrome of blood stagnation(43%) are respectively 0.75, 0.74, 0.69, 0.51 and 0.43 in medical specialist and using linear discriminant function pattern identification are same. The study of inspection, pulse feeling and palpitation will be continued to evaluate concordance rate. Discrimination model will be make to get higher Accuracy and prediction, it means becomes the help in pattern identification diagnosis objectivity and scientific.

  • PDF

Report on the Korean Standard Differentiation of the Symptoms and Signs for the Stroke-1 (한의 중풍변증 표준안-I에 대한 보고)

  • Kim Joong-Kil;Seol In-Chan;Lee In;Jo Hyun-Kyung;Yu Byeong-Chan;Choi Sun-Mi
    • Journal of Physiology & Pathology in Korean Medicine
    • /
    • v.20 no.1
    • /
    • pp.229-234
    • /
    • 2006
  • To develop the Korean standard differentiation of the symptoms and signs for the stroke(KSDS), the committee on Stroke Diagnosis Standardization of traditional Korean medicine(TKM) was organized dy nineteen experts in college of Korean medicine. On July 9th 2005, the second consultation meeting was held in Daejeon, Korea. Fifteen experts of the committee attended the meeting and they discussed the KSDS and came to a consensus. The 15-member committee consensus was as follows: First, board members defined the stroke on the basis of TKM. Second, they divided the symptoms and signs of stroke into five categories- fire and heat, dampness and phlegm, blood stasis, qi deficiency, yin deficiency. Third, the symptom indicator of each differentiation type for the stroke was recommended. KSDS-1 will be applied to the clinical practice and revised.

The Burden of Stroke in Kurdistan Province, Iran From 2011 to 2017

  • Moradi, Shahram;Moradi, Ghobad;Piroozi, Bakhtiar
    • Journal of Preventive Medicine and Public Health
    • /
    • v.54 no.2
    • /
    • pp.103-109
    • /
    • 2021
  • Objectives: The aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017. Methods: Incidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs). Results: The burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively. Conclusions: The burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.

A Study of Received Rehabilitation Service Patterns of Stroke Patients in Metropolis of Korea (우리나라 대도시 뇌졸중 환자의 재활 서비스 수혜 실태에 관한 연구)

  • Bae Sung-Soo;Lee Jin-Hee
    • The Journal of Korean Physical Therapy
    • /
    • v.12 no.3
    • /
    • pp.293-310
    • /
    • 2000
  • This study was performed to investigate rehabilitation service patterns of stroke patients in metropolis of Korea. Seoul, Taegu. Taejon, Pusan and Kwangju from April-July. 2000. Authors developed questionnair, and distributed it to each physical therapist. Total number of distributed questionnaire was 800, and 622 questionnaire were collected and analysed. 1. The occurrence rate of ischemic stroke$(51.1\%)$ was higher than hemorrage stroke$(48.9\%)$. The highest incidence of the stroke was noted in the group or60 years and ratio of male to female 1.3:1 2. The several warning sign is motor deficit$(50.3\%)$, headache. dizziness. vomitting$(32.6\%)$ and difficulty speaking or understanding$(8.2\%)$. 3. The most important contributing factor of stroke was hypertension both hemorrage stroke$(50.7\%)$ and ischemic stroke$(47.2\%)$. 4. In the painful stroke patients$(53.4\%)$, the major problems were shoulder pain$(55.1\%)$ and shoulder-hand syndrome$(31.9\%)$. There is no clinical method for relieving the pain. 5. The seasonal preference was winter and autumn followed by summer and spring in regardless of diagnosis. 6. In the surgery, hemorrage stroke$(61.2\%)$ was higher than ischemic stroke$(13.5\%)$. 7. The major associated impairment were motor deficit$(99.0\%)$, hearing and speech deficit$(30.9\%)$.perception deficit$(15.9\%)$. psychological deficit$(14.1\%)$ and vision deficit$(10.6\%)$. We need more role of speech pathologist and psychotherapist. 8. The rehabilitation services for stroke patients were given only $15\%$ by onset. 9. Medical doctor did not checking everyday$(41\%)$. 10. Patents said that the physical therapist well understanding$(60.1\%)$ than medical doctor$(36.2\%)$ about their conditions.

  • PDF