• Investigative Magnetic Resonance Imaging
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• 제16권2호
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• pp.97-102
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• 2012

고해상도 경동맥 자기공명영상(MRI)을 이용하여 경화판 특성을 파악할 수 있다. MRI는 경화판의 활동성 염증이나 경화판내 출혈을 비침습적으로 진단할 수 있는 능력이 있다. 3T MRI는 1.5T MRI에 비해 신호 대 잡음비와 대조도 대 잡음비가 높다. 동맥벽의 면적이나 표준화된 동맥벽 면적을 MRI로 측정하면 약물 치료 후 반응을 평가할 수 있다. 결론적으로 고행상도 MRI는 일과성 허혈이나 뇌졸중을 발생하기 쉬운 경화판의 진단과 치료 후 평가에 유용하다.

• Childhood Kidney Diseases
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• 제27권2호
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• pp.121-126
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• 2023

The administration of angiotensin type 2 receptor blockers (ARBs) during pregnancy is known to cause ARB fetopathy, including renal insufficiency. We aimed to analyze the outcomes of two patients who survived ARB fetopathy and perform an accompanying literature review. Case 1 was exposed antenatally from a gestational age of 30 weeks to valsartan because of maternal pregnancy-induced hypertension. The patient presented with oliguria immediately after birth, and renal replacement therapy was administered for 24 days. Seven years after birth, renal function was indicative of stage 2 chronic kidney disease (CKD) with impaired urinary concentration. Case 2 had a maternal history of hypertension and transient ischemic attack and was treated with olmesartan until 30 weeks of pregnancy. Renal replacement therapy was performed for 4 days since birth. After 8 years, the patient is with CKD stage 2, with intact tubular function. Recent reports suggest that ARB fetopathy might manifest as renal tubular dysgenesis and nephrogenic diabetes insipidus, in contrast to mild alterations of glomerular filtration. Tubular dysfunction may induce CKD progression and growth retardation. Patients with ARB fetopathy should be monitored until adulthood. The ARB exposure period might be a critical factor in determining the severity and manifestations of fetopathy.

• Journal of Chest Surgery
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• 제55권6호
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• pp.462-469
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• 2022

Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision. Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed. Results: The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21-28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03-1.12; p<0.01) were found to be risk factors for nerve injuries. Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

• 한국한의학연구원논문집
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• 제13권2호통권20호
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• pp.65-69
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• 2007

Background and Purpose : The purpose of this case-control study was to show the relationship between risk factors(past medical history, BMI, WHR, smoking, drinking), warning signs(dyscinesia, sightless, dysarthria, sensory disorder, numbness, blephalospasm, facial spasm, tension) and the incidence of stroke in korean adults. Methods : 455 stroke patients were enrolled as the case group and 180 non-stroke patients as control group from Oct. 2005 to Feb. 2006. Patients were hospitalized within 2 weeks after the onset of stroke. Obesity were defined as $BMI{\geq}25kg/m2$, $WHR{\geq}0.9$ in male and $WHR{\geq}0.8$ in female. Risk factors and warning signs were obtained from personal interview. The analysis of the data was done by chi-square test. Fisher's exact test and test-sample t-test. Results : The percentage of current smokers(or current drinkers) of case group is higher significantly than that of control group. The past medical history of risk factors were found to be transient ischemic attack(p=0.0698), facial palsy(p=0.4061), hypertension(p<0.0001), hyperlipidemia(p=0.1484), DM(p<0.0001), ischemic heart disease(p=0.0093), migraine(p=0.0014) and hypochondria(p=0.2370). $WHR{\geq}0.9$ in male had a 6.696 (3.711-12.082) odds ratio, $WHR{\geq}0.8$ in female had a 1.567 (0.659-3.726) odds ratio. $BMI{\geq}25kg/m2$ had a 2.017(1.263-3.222). The dyscinesia and sensory disorder of warning signs were found to be statistical difference between case and control group. Conclusions : According to the above results, it was found that smoking, drinking, BMI, WHR, hypertension, DM, ischemic heart disease, migraine affected to the incidence of stroke.

• 동의생리병리학회지
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• 제21권6호
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• pp.1611-1618
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• 2007

In this study we investigated the effect of medical history on the incidence of stroke in Korean population. 217 stroke patients were enrolled as a case group. 160 non-stroke patients and 146 normal and non-stroke patients were enrolled as a control and a normal group, respectively, from Jul. 2005 to Mar. 2007. Stroke patients were hospitalized within 2 weeks after the onset of stroke. Medical history was gathered by interviewing each patient. Clinical data were analyzed using SAS software (ver 9.1). Hypertension and diabetes mellitus (DM) were statistically significant in a case group when compared with control and normal groups. Other parameters, such as transient ischemic attack, hyperlipidemia, ischemic heart disease, facial palsy, migraine, and hypochondria, did not show any statistical significance. The same association pattern was observed in the ischemic stroke patients of case group. On the other hand, hemorrhagic stroke patients of case group showed a significant difference in DM when compared with other subject groups. More efficient therapeutic strategy should be considered for patients with medical history, especially hypertensin and DM, to reduce the stroke incidence in Korean population.

• 한국한의학연구원논문집
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• 제1권1호
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• pp.1-14
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• 1995

The clinical study was carried out on 1737 cases of inpatient and outpatient which have been diagnosed as C.V.A at hospital attached to 8 colleges of oriental medicine in Korea or National Medical Center from January 1st 1994 to December 31st 1994. The results were as follows; 1. In this study, the case of Occlusive C.V.D was 70.1%, Cerebral hemorrhage was 20.5%, Transient ischemic attack (T.I.A) was 5.3%, Subdural hemorrhage was 3.0%, Subarachnoid hemorrhage was 0.8% 2. It was confirmed by C.T (20%), E.K.G. (19%), X-ray (19%), Urinalysis (19%), Hematoscopy (20%). 3. The mean days of hospital treatment was 27.88 days, mean days of ambulation was 70.34 days. The mean days of hospital treatment of Occlusive C.V.D, Cerebral hemorrhage, T.I.A., Subdural hemorrhage, Subarachnoid hemorrhage were 25.79, 39.32, 12.49, 16.23, 23.40 days, respectively. The mean days of ambulation of Occlusive C.V.D, Cerbral hemorrhage, T.I.A., Subdural hemorrhage, Subarachnoid hemorrhage were 74.40, 93.68, 69.10, 29.75, 32.57 days, respectavely. 4. Oriental medical treatment of C.V.A was mainly Acupuncture (25%), Paper of Chinese herbs (22%), Chinese physiotherapy (14%), Extract of Chinese herbs (11%). 5. Oriental medical physiotherapy for C.V.A was mostly E.S.T., Kinesiatrics, electric negative therapy, others Aerohydrotherapy, interferential current therapy (I.C.T.), Carbon, Samhogi, T.E.N.S., Ultra-sound, Infra-red, Microwave, T.D.P., Ultraviolet, S.S.P., Chinese herbs beth, Prarffin bath, Magnetic treatment and tractions.

• 대한한방내과학회지
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• 제26권3호
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• pp.699-707
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• 2005

Vertebrobasilar insuffciency(VBI) is also refered to as vertebrobasilar transient ischemic attack(V-B TIA). Vertebrobasilar insufficiency is often undiagnosed or misdiagnosed due to complexity of the symptoms. Transcranial doppler(TCD) can be used to possible to record the blood flow velocities in the cerebral arteries through the intact cranium. Transcranial doppler and magnetic resonance angiography(MRA) are both noninvasive techniques that can be used in vertebrobasilar insufficiency, but transcranial doppler is more sensitive with respect to evaluating stenotic lesion of the arteries than magnetic resonance angiographv. Diagnostic values of transcranial doppler were assessed in patients with vertebrobasilar insufficiency. A case of vertebrobasilar insufficiency is here reported. A 62-year-old man with dizzness, nausea and tremor because of vertebrobasilar insufficiency was admitted at Wonkwang Oriental Medicine Hospital. He was treated with the herbal medicine Chunmagudung-um and with acupunture. Results showed improvement of symptoms and favorable transcranial doppler readings. The process used in this successful treatment is here described.

• 대한한의학회지
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• 제19권2호
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• pp.59-74
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• 1998

Clinical observation was done on 272 cases of patients who were diagnosed as CVA with brain CT, TCD, MRI scan and clinical observation. They were hospitalized in the oriental medical hospital of Kyung-Won University from 1st January to 31st December in 1997. 1. The cases were classified into the following kinds: cerebral infarction, cerebral hemorrhage. and transient ischemic attack. The most case of them was the cerebral infarction. 2. There is no significant difference in the frequency of strokes in male and female. And the frequency of strokes was highest in the aged over 50. 3. In cerebral infarction the most frequent lesion was the territory of middle cerebral artery, and in cerebral hemorrhage the most frequent lesion was the basal ganglia. 4. The most ordinary preceding disease was hypertension. and the next was diabetes. 5. The rate of recurrence was high in cerebral infarction. 6. The cerebral infarction occurred usually in resting and sleeping, and the cerebral hemorrhage in acting. 7. The common symptoms were motor disability and verbal disturbance. 8 The average time to start physical therapy was 1l.3rd day after stroke in cerebral infarction and it was 15.2th day after stroke in cerebral hemorrhage. 9. The common complications were urinary tract infection, pneumonia, myocardial infarction. 10. Hypercholesterolemia and hypertriglyceridemia are usually found more frequently in cerebral infarction than in hemorrhage. 11. In acute or subacute stage, the methods of smoothening the flow of ki(順氣), dispelling phlegm(祛痰), clearing away heat(淸熱) or purgation(瀉下) were frequently used. and in recovering stage, the methods of replenishing ki(補氣), tonifying the blood(補血) or tranquilization(安神) were frequently used.

• Journal of Chest Surgery
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• 제56권2호
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• pp.90-98
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• 2023

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Totally thoracoscopic ablation (TTA) is a surgical treatment showing a high success rate as a hybrid procedure with radiofrequency catheter ablation to control AF. This study compared the early complications of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) in patients who underwent TTA. Methods: This single-center retrospective cohort study enrolled patients who underwent planned TTA for AF from February 2012 to October 2020. All patients received postoperative anticoagulation, either with warfarin or a NOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). Propensity score matching was performed for both groups. Early complications were assessed at 12 weeks after TTA and were divided into efficacy and safety outcomes. Both efficacy and safety outcomes were compared in the propensity score-matched groups. Results: Early complications involving efficacy outcomes, such as stroke and transient ischemic attack, were seen in 5 patients in the warfarin group and none in the NOAC group. Although the 2 groups differed in the incidence of efficacy outcomes, it was not statistically significant. In safety outcomes, 11 patients in the warfarin group and 24 patients in the NOAC group had complications, but likewise, the between-group difference was not statistically significant. Conclusion: Among patients who underwent TTA, those who received NOACs had a lower incidence of thromboembolic complications than those who received warfarin; however, both groups showed a similar bleeding complication rate. Using a NOAC after TTA does not reduce efficacy and safety when compared to warfarin.

• Journal of Korean Neurosurgical Society
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• 제65권6호
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• pp.801-815
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• 2022

Objective : To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods : We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results : There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion : The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.