• The Journal of Internal Korean Medicine
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• v.28 no.1
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• pp.34-46
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• 2007

Objectives: This study was to assess characteristics in acute stroke patients according to Sasangconstitution (SC). Methods : We assessed the type of SC of acute stroke patients in $2^{nd}$ Department of Internal Medicine at KyungHee University Oriental Hospital from October 2005 to September 2006. Each subject's SC type was confirmed when the result of QSCC II+ was in accordance with the opinion of the Sasangconstitutional medicine specialist. We investigated general characteristics, stroke type, blood test results, alcohol drinking, smoking and dietary preferences according to SC. Results: 108 subjects were included in the final analysis. This study showed that out of the total patients, the proportion of So-yang to Tae-eum to So-eum was equal to 5.5 to 3.5 to 1. Especially, men were higher proportion So-yang while women recorded a more significant ratio of Tae-eum. Also, the BMI, waist circumference, hip circumference, and WC/HC ratio recorded significantly high results. The result indicated that even though the Tae-eum let on the highest numerical value in the aspect of their past history and the final diagnosis, no significant difference was revealed according to SC. The ratio of cerebral infarction to cerebral hemorrhage was 9 to 1. SVO, LAA, SUE are the 3 types of cerebral infarction classified by TOAST; SVO ranked the highest while SUE ranked the lowest in all constitutions. The blood test result displayed that averages of both TL and the T-chol were the highest in Tae-eum while that of hematocrit in So-yangand that of HDL-chol in So-eum. However, there was no significant difference. There were no significant differences classified by gender or by SC in the aspect of the alcohol drinking and smoking history. The majority of So-yang and Tae-eum demonstrated a preference for meat while So-eum and So-yang displayed high preferences for sea food. Conclusions : With respect to these results. we could observe the general disposition of various characteristic distributions according to SC of acute stroke patients. For further research in this field. it seems necessary to construct fundamental databases for the prevention and treatment of stroke by increasing the number of patients observed and by analyzing delicate characteristics of each constitution type.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.422-434
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• 1980

Since 1968 up to the end of October 1980, 448 valves were replaced in 354 patients in Seoul National University Hospital. There were 238 mitral, 38 aortic, 7 tricuspid, 45 aortic with mitral, 23 tricuspid with mitral, and 3 triple valve replacement aortic mitral and tricuspid cases. Annual increase of mitral valve replacement cases and decrease of operative maortality were remarkable. Recently operative mortality of mitral valve replacement is about 5%. Sex ratio of mitral valve replacement is almost equal and there were 12 cases of pediatric patients (5%) among 238 cases, and patients under the age of 20 years were 34 (14.3%). Mitral valve replacement was done for 199 single mitral, 38 double valve and one triple valve lesions. Among 238 mitral valve replacement paients left atrial thrombus in 23(9.7%), atrial fibrillation in 132 (55.5%), and reoperation after blind mitral commissurotomy in 12(5%) cases were noted. In recent cases bioprosthetic valves, mainly lonescu-shiley valve were utilized to overcome the difficulties of postoperative late complications in anticoagnuation, especially for the rural patients and pediatric cases, in addition to the hemodynamic advantages of lonesocu valve. Among 354 patients 16 cases were congenital heart anomaly related, 5 ventricular septal defect related aortic and 4 Ebstein related tribuspid valve replacement cases. There were 2 congenital anomaly related mitral valve replacements, one for congenital mitral insufficiency of 7 years old boy and one for corrected transposition of the great vessels associated with mitral insufficiency. Among total 354 valve replacements 49 operative deaths (13.3%) were noted and in 238 mitral valve replacement 24 operative deaths occurred (10.1%). In 39 patients among 354 total valve replacements late complications were found. In 238 mitral valve replacement cases late complications were noted in 26 patients, among whom 16 cases expired. Main late complications were thrombe-embolism, subacute becteerial endocarditis, arrythmia cerebral hemorrhage due to unsatisfactory anticoagulation, and congestive heart failure in the incipient period of valve replacement were also noted. In mitral valve replacement cases long-term survival rate was 83.2% who showed marked clinical improvement. Ther were no evidences of calcification during the 2 years follow-up period for the lonescu-valve replacement cases among 19 pediatric patients. In conclusion 238 cases of mitral valve replacement were done with 24 operative deaths and 26 late complication cases among whom 16 expired. The long term survival was 83.2% of the cases. In pediatric cases in place of coumadin anticoagulation Persantin **** 75 and aspirin were administered after valve replacement. In adult cases who have difficulaties with coumadin anticoagulation and for those even with bioprosthetic heart valve replacement who needs long-term or permanent anticoagulation persantin 75 and aspirin combination regimen were administered with antisfactory results.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.914-921
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• 1997

Hereditary hemorrhagic telangiectasia(Osler-Rendu-Weber Syndrome) is characterized by telangiectasia of the skin and mucous membranes and intermittent bleeding from vascular abnormalities. About 20% of patients with this syndrome have pulmonary arteriovenous fistulas. Pulmonary arteriovenous fistula is uncommon malformation which has an abnormal connection between the pulmonary capillary bed, in which venous blood in the pulmonary artery is shunted through the fistula into the pulmonary vein without exposure to alveolar oxygen and result in unoxygenated, desaturated systemic arterial blood, polycythemia, cyanosis and clubbing. Death often results from cerebral abscess and rupture of the malformation with massive hemorrhage. Therapeutic intervention is recommended for all symptomatic patients because of the risk of those serious complications. Treatment options include surgery and transcatheter obliteration with steel coils or detachable balloons. Therapeutic embolization has the advantages that multiple bilateral pulmonary arteriovenous fistulas can be occluded and also that the procedure can be repeated if necessary. Recently we experienced a case of the multiple bilateral pulmonary arteriovenous fistulas associated with telangiectatic change of hepatic artery and multiple angiodysplasia on the gastric mucosa in 41 years old female patient who had mild dyspnea of exertion(NYHA class II). clubbing finger, severe iron deficiency anemia. She was treated with embolization technique using steel coils and iron replacement. After the therapeutic embolization. significant improvement of dyspnea of exertion with disappearance of multiple pulmonary nodule on follow-up simple chest x-ray was noted. During the subsequent six months follow-up period, she had the improvement of symptoms and iron deficiency anemia.

• Proceedings of the Korean Environmental Health Society Conference
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• 2005.12a
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• pp.87-94
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• 2005

Results from previous studies revealed that metal level in the body is related to certain types of diseases. For example. serum copper level with chronic heart failure, iron and transferrin in the blood serum with acute cerebral vascular diseases, Zn in the CNS, lead with neurotoxicity, hypertension, genetic damage, arsenic with cancer skin lesion, Al with neurobehavioral function (cognitive impairment and memory disorder), and etc. The rate of stroke has increased in recent years and several metals were found to be responsible for causing stroke. This study compared several blood metal concentrations between stroke and non-stroke patients. Patients with stroke (116 samples) and non-stroke (111 samples including lowback pain and others) participated in this study. Total of 227 blood samples were collected and participants completed questionnaires regarding age, gender, occupation, residence, alcohol, smoking, and etc. To be qualified into the stroke group, patients have never experienced stroke previously. Subjects only included ischemic stroke and intracerebral hemorrhage patients diagnosed by brain CT and brain MRI. Patients with high risk of metal exposure such as herbal intake and job related exposure were excluded. 10ml of blood samples were analyzed by ICP-MS method at the Center of Nature and Science at Sangji University. Metal geometric mean (SD) concentrations in blood of study subjects showed higher values, 2.64-36.12%, than WHO reference values in Mn, Ni, Hg, Se, and As. Metal concentration in blood of stroke patients non-adjusted for potential confounders was higher except for Hg and also higher except for Ni in adjusted for potential confounders. Co was significantly higher in stroke patients (p=0.002) than non-stroke patients adjusted for potential confounders. Regression coefficient values of stroke patients was 0.17-8.25 in each metals. Odd ratio of stroke patients had 0.96 (Ni)-2.68 (Co) compared to non-stroke cases. This result means that Co increase of 1 raises the risk ratio of stroke by 2.86 times. Based on the results, metal concentration in blood seems to affect incidence of stroke.

• Journal of Korean Physical Therapy Science
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• v.3 no.3
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• pp.57-64
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• 1996

The purpose of this study is to investigate risk factor found in the patients with stroke in physical therapy. A questionnaire survey was carried out for 130 the patients, who had comparatively alert mentality, hospitalized in kyung hee oriental medical hospital with stroke from January, 1st to May 31st, 1996. Major findings of this stuty were as follows. 1. The stroke patients 67(51.5%)were males and 63(48.5%) femals. The age groups of 50 to 69 years accounted for 67.6% of the total stroke patients are the highest. The job groups of commerce and business of patients 58.5%. The living groups of major citys of the revealed the highest incidence(40.8%). 2. There were 40 patients (30.8 %) who had hemorrhage related condions as the direct cause of their stroke, and 90 patients (69.2 %) who had cerebral infarction with no hemorrhaging as the cause. of the disease that the patients suffered from before their stroke, blood pressure related problems were most numberous 76 patients(58.5%) had such problems. 3. A month before their attack of stroke, were asked what thay thought could become the causes of their strokes. The most frequently mentioned answers were fatigue, drinking too much, and smoking, as chosen by 45 patients(34.6 %). 4. In regarding the relation between stress and stroke, (37.7%), of the surveyed belonged to the most numerous group had of people who said they were not under stress. Yet this group had a large number of parents. And 22.3 % of the surveyed named conflicts among parents, siblings, and relatives. 5. Questions were asked to find out the relationship between complications of stroke and smoking or drinking. It was surprising to see a high rate of attack among the 55.4 % majority who answered that they did not smoke nor drink. 6. To sum up the affect of food on attack of stroke, 42.5% of the people who had a sprcey and salty diet had a higher rate of attack then the group of people with leisurely nature. 7. Looking at the family history, 40.4% of the patients said their parents also suffered the disease. This percentage is the highest. And 40.0% answered that there is no one who suffered in their family history. Judging from the percentages and family.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.112-127
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• 1987

Myasthenia gravis is a neuromuscular transmission function disorder characterized by fatigue and weakness of voluntary muscles. This muscular weakness is intensified by activity and stress, and improved by the use of anticholinesterase compounds. It was initially described by Erb in 1879 and later named myasthenia gravis by Jolly in 1895. Although the pathogenesis is Known to be an autoimmune related reduction in the number of available acetylcholine receptors at neuromuscular junctions, the role of thymus in myasthenia gravis is still unclear and under investigation. Thymectomy in the management of myasthenia gravis has become increasingly important since Dr. Blalock observed in 1939 that some patients with thymic tumors and myasthenia gravis improved following thymectomy. A clinical study of 102 cases of myasthenia gravis was performed at Yonsei University College of Medicine. Seoul, Korea from Jan. 1976 to Jun. 1986. In order to determine which factors are of prognostic significance, attention is focused upon pre-operative patient evaluation, problems in operative and post-operative care, and long-term follow-up observations. The results were as follows: 1. The sex distribution was 67 females and 35 males, the mean age of onset was 28.95*1.69 years, and the maximal incidence occurred between 21 and 40 years of age [56 cases: 54.9%]. 2. Clinical manifestations of ocular symptoms were seen to 70 patients [68.6%] extremities weakness in 33 [32.3%], bulbar weakness in 29 [28.4%], and dyspnea in 13 [12.7%]. 3. Study cases more than two thirds were classified as mild types [MG 1 and MG 11A] and 6 cases as grave [MG 1V] based on the modified Osserman`s classification system, 4. Thymectomy was performed in 19 cases which presented in severe myasthenia symptoms and showed no improvement with cholinergic drugs. Histologic examination of the excised thymus glands revealed no abnormalities in 4 cases, thymic hyperplasia in 5, benign thymoma in 5, and malignant thymoma in 5. 5. Immediate post-operative complications included 2 cases of pneumothorax which were treated by tube thoracostomies, there was no operative mortality. 6. The response to cholinergic drugs in 36 cases younger than 20 years old and in 27 cases older than 40 years was relatively poor, while that in 35 cases between the ages of 21 and 40 years old was good. 7. Thirty of 39 cases in groups IIB, III & IV improved markedly with medical or surgical management while only 16 of 59 cases in the mild groups [I and IIA] improved, almost all surgical cases improved in all categories. 8. There were 5 deaths. occurring between 7 months and 3 years 3 months of treatment of myasthenia gravis. The causes of death were myasthenic crisis in 2 cases, respiratory failure due to candidiasis & radiation pneumonitis in one case, cerebral hemorrhage due to high blood pressure in two case.

• Journal of Korean Neurosurgical Society
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• v.57 no.5
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• pp.342-349
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• 2015

Background : Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system. Method : A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes ($mRS{\leq}2$) at 3 month were compared across the three method. Results : Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331). Conclusion : Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.723-729
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• 2017

Objective : Acute subdural hematoma (ASDH) is generally considered a condition that should be managed surgically. However, some patients initially receive conservative treatment, a subset of whom require surgical intervention later. This study aimed to evaluate the predictors of delayed surgical intervention in ASDH patients who are initially managed conservatively. Methods : From January 2007 to December 2015, 842 patients diagnosed with ASDH were treated at our institution. Among them, 158 patients with convexity ASDH were initially treated conservatively. Patients were divided into a delayed surgery group and a conservative group. Demographic characteristics, past medication and medical histories, and radiological and laboratory data were collected by retrospective chart review. Independent risk factors were identified with univariate and multivariate analyses. Results : Twenty-eight patients (17.7%) underwent delayed surgical intervention. Their mean age was 69.0 years, and 82.1% were male. Hypertension, diabetes mellitus, and heart disease prevalence and use of anti-platelet agents did not significantly differ from the conservative group. However, age (p=0.024), previous cerebral infarction history (p=0.026), increased maximal hematoma thickness (p<0.001), midline shifting (p=0.001) and accompanying subarachnoid hemorrhage (p=0.022) on initial brain computed tomography (CT) scan, low hemoglobin level (p<0.001), high leukocyte count (p=0.004), and low glucose level (p=0.002) were significantly associated with delayed surgical intervention. In multivariate analysis, increased maximal hematoma thickness (odds ratio [OR]=1.279, 95% confidence interval [CI] 1.075-1.521; p=0.006), low hemoglobin level (OR=0.673, 95% CI 0.467-0.970; p=0.034), and high leukocyte count (OR=1.142, 95% CI 1.024-1.272; p=0.017) were independent risk factors for delayed surgical intervention. Conclusion : Due to the high likelihood of delayed surgical intervention among minimal ASDH patients with a thicker hematoma on initial brain CT, lower hemoglobin level, and higher leukocyte count, these patients should receive more careful observation.

• Journal of Oral Medicine and Pain
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• v.33 no.2
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• pp.111-120
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• 2008

Purpose : To investigate the actual conditions of diagnosis and treatment of oral disease of inpatient with systemic disease. Methods : A total of 110 subjects, inpatient due to systemic disease for diagnosis and treatment of oral disease was requested to answer the medical history and dental treatment record. Results : In the main systemic disease, Endocrine, nutritional and metabolic diseases is composed of Gingivitis and periodontal diseases 44.9%, Diseases of salivary glands 22.4%, Within Normal Limit, Dental caries 12.2%, Diseases of pulp and periapical tissues 4.1%, Embedded and impacted teeth, Other diseases of hard tissues of teeth 2%. In the main oral disease, Gingivitis and periodontal diseases is composed of Non-insulin-dependent diabetes mellitus 39.2%, Cerebral infarction 29.4%, Nerve root and plexus disorders 5.6%, Intracerebral hemorrhage 3.9%, Malignant neoplasm of stomach, Thyrotoxicosis, Schizophrenia, Alcoholic liver disease, Nephrotic syndrome 2%. Conclusion : These findings indicate that inpatient due to the systemic disease is significantly correlated to the oral disease. The patients of oral disease interrelationship between inpatient and outpatient of systemic disease should be validated by future research.

• The Journal of Internal Korean Medicine
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• v.19 no.2
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• pp.28-36
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• 1998

Background : Yang-do-rack is frequently used in diagnosing syndromes in oriental medical hospital, but there has been few clinical report on Yang-do-rack. So we intended to find out the relationship among Yang-do-rack, general characteristics and the differentiaion of syndromes in acute stroke patients. Materials and Methods : In this study we selected the subjects who were hospitalized from March 1, 1998 to July 31. 1998 at the department of circulatory internal medicine at college of oriental medicine, in Kyung-Hee University, diagnosed acute cerebral infarction or hemorrhage within 7 days after onset time. We checked Yang-do-rack scores with Autonomic Nervous System YORAK (Sord Medicom co. Ltd, Korea) and calculated the scores of each diffentiation of syndroms. Resuts : 1. In left leg meridian, there was more numerical value male than female on LF1, LF2, LF4, LF6. The value of LF1, LF3, LF4, LF5 was getting lower as the score of heat-transformation syndrom(火熱證) increased. 2. In left arm meridian, there was more numerical value male than female on LH2, LH5. The value of LH1, LH3, LH5 was getting lower as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. 3. In right leg meridian, there was more numerical value male than female on RF1, RF2, RF4, RF6. The value of RF3, RF5 was getting lower as the score of heat-transformation syndrom(火熱證) increased and RF4 as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. 4. In right arm meridian, the value of RH1 was getting lower as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. These results show that the Yang-do-rack diagnosis could offer supplemental help for diffrentiation of syndroms in acute stroke patient.