• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.423-429
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• 2018

Objective: Falling is a common cause of head injury in preschool aged children. We investigated the characteristics of mild head injuries caused by falling and the association between body weight and occurrence of traumatic brain injuries (TBI). Methods: This retrospective observational study was conducted on head-injured preschool-aged children that visited the emergency department from January 2012 to December 2015. Characteristics such as age, sex, weight, free fall height, floor type, and presence of TBI, as defined as cerebral hemorrhage or skull fracture, were investigated. We calculated body weight percentiles by calibrating age and weight and categorized them into four quartile ranges. We grouped all included cases into two groups according to the presence of TBI. The characteristics of the two groups were compared by using chi-square test, and the association with TBI was investigated by using binomial logistic regression. Results: A total of 701 children were included, and TBI was observed in 95 children. Children with TBI were younger. The proportion of children with TBI was higher in the third and fourth quartiles of the body weight group as well as according to soft floor and fall from high height (${\geq}1m$). The odds of soft floor being associated with TBI was higher than the odds for hard floor (odds ratio, 2.734; 95% confidence interval [CI], 1.597-4.680). The odds of high height (${\geq}1m$) being associated with TBI was higher than that for low height (odds ratio, 2.306; 95% CI, 1.155-4.601), and the odds ratio for the weight percentile group was 1.228 (95% CI, 1.005-1.499). Conclusion: Prevalence of TBI after falling in preschool-aged children might be associated with high fall-height and body weight quartiles.

• The Journal of Internal Korean Medicine
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• v.42 no.5
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• pp.1035-1044
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• 2021

Objective: This study investigated two cases of Korean medical treatment for visual field impairment after stroke: Case 1, a 56-year-old male with a posterior cerebral artery infarction and right homonymous hemianopsia, and Case 2, a 46-year-old male with an intracerebral hemorrhage in the left parietal lobe and right homonymous hemianopsia. Methods: Case 1 was treated with acupuncture, electroacupuncture, and herbal medicine (Mangeum-tang) for two months, and Case 2 was treated with acupuncture, electroacupuncture, and herbal medicine (Oryeong-san) for 40 days. Results: Following treatment, for Case 1, the Humphrey visual field test showed improvement. The visual field indexes (VFIs) for the left and right eyes improved from 44% to 55% and 49% to 64% respectively, and the mean deviations (MDs) for the left and right eyes improved from -21.11 dB to -19.91 dB and -17.45 dB to -13.89 dB, respectively. The mean visual sensitivities (MVSs) of the left and right eyes also improved from 8.67 dB to 11.33 dB and 1.67 dB to 9.67 dB, respectively, with no side effects. For Case 2, the VFI for the left eye improved from 36% to 64% and that for the right eye remained unchanged. The MDs for the left and right eyes also improved from -22.02 dB to -14.47dB and -22.11 dB to -21.34 dB, respectively, with no side effects. Conclusions: This study suggests that Korean medical treatment may improve visual impairment after stroke, but further research is needed.

• Journal of Chest Surgery
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• v.55 no.5
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• pp.378-387
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• 2022

Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database. Methods: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision. Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib. Conclusion: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

• The Journal of the Korea Contents Association
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• v.22 no.2
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• pp.794-802
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• 2022

This retrospective study was to investigate the characteristics of unplanned readmission and factors affecting readmission within 30 days of discharge in patients who underwent heart valve surgery through electronic medical records. The participants were 423 unplanned re-hospitalization within 30 days after heart valve surgery at a tertiary hospital in Seoul from January 2018 to August 2019. A total of 48 patients (11.3%) were unplanned readmissions, and the most common causes were atrial fibrillation in 13 cases (27.1%) and pain at the surgical site in 13 cases (27.1%). Other causes were: 10 cases (20.8%) of warfarin inappropriate treatment concentration, 7 cases of general weakness (14.6%), 5 cases of hypotension (10.4%), 4 cases of pericardial effusion (8.3%), 3 cases of surgical wound infection (6.3%), 3 cases of hemorrhage (6.3%), 3 cases of high fever (6.3%), and 1 case of cerebral infarction (2.1%). Variables influencing readmission were history of cancer (OR = 2.60, 95% CI 1.13-6.03, p = .025) and the patients who went to a home rather than a hospital after discharge (OR = 2.91, 95% CI 1.33-6.36, p = .008), as a type of valve surgery, mitral valve valvuloplasty had a higher readmission rate than aortic valve replacement (OR = 1.21, 95% CI 1.21-4.98, p = .012). In order to reduce unplanned readmissions, an tailored education program is needed to enable patients and caregivers to manage their comorbid chronic diseases before discharge and assess risk factors for readmission in advance.

• The Journal of the Society of Stroke on Korean Medicine
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• v.7 no.1
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• pp.46-53
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• 2006

Objectives : The purposes of this study were to investigate that a blepharospasm means the presymptom of stroke based on the traditional hypothesis in the oriental medicine and to compare a blepharospasm with warning signs of stroke in the western medicine. Methods : In the time period Oct. 2005 to Oct. 2006, 409 patients with a first-ever stroke admitted in the department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital, Kyunghee University Oriental Medical Hospital, Dongguk Il-san Oriental Medical Hospital were included. Patients were hospitalized within 14 days after the onset of stroke. Stroke patients were interviewed by residents who studied standard operation procedures in Fundamental Study for Standardization and Objectification of Differentiation and Pattern Identification of Syndrome of Oriental Medicine for Stroke. A questionnaire was completed by a question-and-answer form between patients and residents after explanation details to patients and the agreement of patients. Results : Age, care of patients or grandson, diabetes mellitus, and smoking were higher among cerebral infarction group, while smoking was higher among hemorrhage group. Female, young age, hyperlipidemia, hypertension in the family history and fat body in waist-hip ratio were higher among patients undergoing the blepharospasm before stroke onset. And the incidence of blepharospasm was lower in patients who dislike the fast food. Finally, when we compared a blepharospasm with warning signs of stroke in the western medicine, the incidence of blepharospasm in this study were the most frequent. Conclusion : In this study, the incidence of blepharospasm in patients before stroke onset was more frequent than that of warning signs in the western medicine. But more data from prospective cohort studies should be collected to be accepted that the blepharospasm is the presymptom of stroke as like warning signs in the western medicine.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.690-702
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• 2023

Objective : To analyze the outcomes of coil embolization (CE) for unruptured intracranial aneurysm (UIA) according to region and hospital size based on National Health Insurance Service data in South Korea. Methods : The incidence of complications, including intracranial hemorrhage (ICRH) and cerebral infarction (CI), occurring within 3 months and the 1-year mortality rates in UIA patients who underwent CE in 2018 were analyzed. Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs) or semigeneral hospitals (sGHs) according to their size, and the administrative districts of South Korea were divided into 15 regions. Results : In 2018, 8425 (TRGHs, 4438; GHs, 3617; sGHs, 370) CEs were performed for UIAs. Complications occurred in 5.69% of patients seen at TRGHs, 13.48% at GHs, and 20.45% at sGHs. The complication rate in TRGHs was significantly lower than that in GHs (p=0.039) or sGHs (p=0.005), and that in GHs was significantly lower than that in sGHs (p=0.030). The mortality rates in TRGHs, GHs, and sGHs were 0.81%, 2.16%, and 3.92%, respectively, with no significant difference. Despite no significant difference in the mortality rates, the complication rate significantly increased as the number of CE procedures per hospital decreased (p=0.001; rho=-0.635). Among the hospitals where more than 30 CEs were performed for UIAs, the incidence of CIs (p=0.096, rho=-0.205) and the mortality rates (3 months, p=0.048, rho=-0.243; 1 year, p=0.009, rho=-0.315) significantly decreased as the number of CEs that were performed increased and no significant difference in the incidence of post-CE ICRH was observed. Conclusion : The complication rate in patients who underwent CE for UIA increased as the hospital size and physicians' experience in conducting CEs decreased. We recommend nationwide quality control policies CEs for UIAs.

• The Korean Journal of Physiology
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• v.2 no.2
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• pp.33-43
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• 1968

Histamine, 0.5 mg as histamine base in 4 ml of normal saline solution, was injected into rabbits anesthetized with nembutal and the mean blood pressure was kept in the range of $52{\sim}80\;mmHg$ for over one hour by supplemental additions. Following the injection of the test substances, 300 mg of urea and 200 mg of antipyrine intravenously, serial blood samples were obtained from the femoral artery and the internal jugular vein at $0.5{\sim}3$ minutes interval. The decreasing patterns in the concentrations of arterial and venous blood plasma samples were compared with each other. The ratio of the concentration of brain tissue to that of the final arterial plasma was also studied. By these measures the degrees of penetration of the test substances in the brain in the control and in the histamine treated rabbits were observed. The concentrations of antipyrine and urea in the arterial blood plasma were decreasing exponentially with respect to the time elapsed. The venous concentrations were anticipated to increase initially and to cross the arterial concentration curve in the point of equlibrium between the plasma and the tissue. On the contrary to the expectation venous concentration also revealed the decreasing tendency similar to that of arterial plasma. The similarity between these two curves, arterial and venous, would be atributable to the fact that the cerebral blood flow rate was large enough and the rising phase in the venous concentration curve was instantly over before serial blood samples were taken. Inspite of some similarity in the decreasing tedency in both concentration curves there were appreciable discrepancies between the arterial and venous plasma which would reflect the situation far from the equlibria among several compartments in the brain. Changes in plasma potassium levels caused by the injection of histamine or bleeding were observed, too. Using 8 rabbits as the control and 12 rabbits for the histamine treated group following results were obtained: 1. Both of the concentration curves, arterial and venous, declined rapidly at_first and slowly later on and approached same equilibrium concentration with the passage of time after a single injection. The time at which attained the same concentration was $2.0{\pm}0.54\;min.$ in the control and $4.3{\pm}1.92\;min.$ in the histamine treated group with respect to antipyrine. On the other hand in the case of urea they were $2.4{\pm}0.59\;min.$ in the control and $4.4{\pm}1.31\;min.$ in the histamine group, respectively. In the histamine treated group enlarged spaces for distribution of test substances were postulated. 2. The concentration of antipyrine in the brain tissue water revealed no significant differences between the control and experimental groups, showing $212{\pm}40.2\;mg/l$ in the control and $206{\pm}64.1\;mg/l$ in the histamine treated group. On the other hand urea revealed higher value in the histamine treated group than in the control, showing an enhanced penetration of urea into the tissue after injection of histamine. Urea concentration in the brain water was $32.3{\pm}3.36\;mg%$ in the control and $39.2{\pm}4.25\;mg%$ in the histamine treated group. 3. The distribution ratio of antipyrine in the brain tissue was very close to unity in the histamine treated animals as well as in the control. 4. The average of the distribution ratio of urea in the control animals was 0.77 and it showed the presence of blood-brain barrier with regard to urea. However in the histamine treated animals the distribution ratios climbed up to 0.86 and they were closer to unity than in the control animals. Out of 12 cases 5 were greater than 0.9 and 8 exceeded 0.85. It appeared that histamine enhanced the penetration of urea through the barrier. 5. Histamine injection and or hemorrhage caused an elevation of the concentration of potassium in plasma. In the event that histamine and hemorrhage were applied together the elevation of potassium exceed the elevation seen at the histamine alone. There was no evidence that the leakage of potassium from the brain tissue was dominant in comparison with the general leakage from the whole body.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.768-774
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• 1999

Background: It is well known that rifampin decreases the hypoprothrombinemic effect of warfarin by induction of cytochrome P-450 enzyme in healthy volunteer. However, in patients the dosage schedule of warfarin during rifampin therapy is not established. Therefore, patients taking both rifampin and warfarin were reviewed to find out the adequate dosage schedule of warfarin in addition to side effects by interaction of two drugs. Method: Patients taking both rifampin and warfarin were retrieved from patients who were admitted due to heart disease and tuberculosis at Boochun Sejong Hospital from January of 1995 to August of 1999. To decide the adequate dosage of warfarin, the dosage of warfarin before, during, and after rifampin was evaluated in patients who kept adequate hypoprothrombinemic effect of warfarin during rifampin. To decide the adequate dosage schedule of warfarin, the time interval from the beginning of rifampin to normalization of prothrombin time(INR$\geq$1.1) was evaluated. And, the side effects by interaction of two drugs were reviewed. Results: All 12 patients taking both rifampin and warfarin were retrieved. Among them only 6 kept adequate hypoprothrombinemic effect of warfarin during rifampin. The dosage of warfarin during rifampin was $2.4{\pm}0.6$(mean$\pm$standard deviation) times as much as that before rifampin but the dosage after rifampin was the same as that before rifampin. The time interval from the beginning of rifampin to normalization of prothrombin time was $5.8{\pm}2.9$(mean${\pm}$standard deviation) days. 2 out of 12 had complication related to the interaction of rifampin and warfarin, one cerebral embolism just after the beginning of rifampin and the other cerebral hemorrhage just after the discontinuation of rifampin. Conclusion: When both rifampin and warfarin are prescribed, it would be a possible method to be confirmed by prospective study that warfarin be gradually increased about 2 times more than that without rifampin over 1 week or so after the beginning of rifampin and be tapered to the same dosage as that before rifampin when rifampin is discontinued. And, it would be prudent that prothrombin time be monitored frequently during rifampin and warfarin therapy, especially the beginning or discontinuation of rifampin.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.104-112
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• 1998

Purpose : To evaluate the clinical utility of diffusion-weighted imaging by analyzing the signal intersity of lesions in patients with various intracranial diseases. Materials and Methods : difusion-weighted MR imaging was prospectively perormed in randomly selected 70 patients with various intracranial idseases. They consisted of 20 patients with acute infarct, 21 patients with chronic infarct of small vessel disease, 14 patients with primary intracranial tumor, three patients with brain metastasis, five patient with brain abscess, five patients with brain abscess, five patients with cerebral hemorrhage, one patient with neurocysticercosis, and one patient with epidermoid cyst. the diffusion-weighted images were obtained immediately after routine T2-weighted imaging on a 1.5T MR unit using single shot spin echo EPI technique with 6500 ms TR, 107ms TE, $128{\times}128$ matrix, 1 number of excitation, $24{\times}24$ field of view, 5-7 mm slice thickness, 2-3 mm inter-slice gap. The diffusion-gradients (b value of ($1000s{\;}/{\;}textrm{mm}^2$)) were applied along three directions(x, y, z). On visual inspection of diffusion-weighted images, the signal intersity of lesions was arbitrarily graded as one of 5 grades. In quantitative assessment, we measured the signal intensity of all the lesions and the contralateral corresponding normal area using round region of interest(ROI), and then calculated the signal intensity ratio of the lesion to the normal brain parenchyma. Results : On visual inspection, markedly hyperintense signals were seen in all cases of acute infarct, brain abscess, epidermoid cyst, and neurocysticercosis in degenerating stage. In all cases of cerebral hematoma, the very high signal internsity was intermingled with low signal intensity. focal very high signal intersity was also seen in a solid portion of the tumor in a patient. the mean signal intensity ratios of all those lesions to the normal brain parenchyma were above 2.5. Gliosis, solid component of brain tumor, brain metastasis, and vasogenic dedma appeared isointense to the normal brain parenchyma in 71%, 64%, 100%, and 67%, respectively ; the mean signal intensity ratios of those lesions to the normal brain parenchyma ranged 1.15 to 1.28 and there was no significant difference among these(p>0.1). Cystic cerebromalacia and necrotic or cystic portions in tumor were markedly or slightly hypointense, and the mean signal intensity ratios were 0.45 and 0.42, respectively. Conclusion : Very high signal intensity of acute infarct, brain abscess, epidermoid cyst, and cystic neurocysticercosis in degenerating stage on diffusion-weighted images may be helpful in differentiating from other diseases that are hypointense or isointense to the normal brain parenchyma. It may be especially useful differentiation of brain abscess from brain tumor with necrotic or cystic portion.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.875-882
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• 1996

Multlvalvular heart surgery was performed In 78 cases, in the Department of Thoracic & Cardiovascu far Surgery of Chonbuk national University Hospital from november 1983 to March 1994. There Where 31 men and 47 women. whose ranged from 14 to 63 years. The causes of the valvular lesions were 57 rheumatic origin, 18 degenerative, 1 previous endocarditls, 1 prosthetic valve mal-function. There were 25 double valve replacement with or wit out tricuspid valve repair, i M VR and aortic valve repair, 18 MVR and tricuspid valve repair, 1 MVR and aortic and tricuspid valve repair, 10 AVR and mi- tral valve repair, 1 AVR and tricuspid valve repair, 8 mitral aortic valve repair, 13 mitral and tricuspid valve repair. They were improved mean New York Heart Association functional cldss, from 2.72% 121 Early deaths were 5 cases(6.4%). The cause of death wet'e low cArdiac output syndrome. veritricular tachycardia, massive bleeding and cerebral thromboembolism. All the survivors belonged to New York Heart Association functional class I or ll at discharge. The patients who had had valve replacement operation were medicated with warfarin to maintain the level of 30∼ 50% of normal prothrombin time. During follow-up(93.6%, mean 49.9 months), 2 late deaths were developed. One was due to intracranial hemorrhage and the other congestive heart failure. The pre-operative New York Heart Association Functional class IV was statistically sig ificant operat- ive risk factors(p< 0.05).