• Journal of Korean Neurosurgical Society
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• 제63권5호
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• pp.598-606
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• 2020

Objective : The purpose of this study was to evaluate the impact of time interval between index event and stenting on the periprocedural risk of stenting for symptomatic carotid stenosis and to determine the optimal timing of stenting. Methods : This retrospective study included 491 (322 symptomatic [65.6%] and 169 asymptomatic [34.4%]) patients undergoing carotid stenting. The symptomatic patients were categorized into Day 0-3, 4-7, 8-10, 11-14, 15-21, and >21 groups according to the time interval between index event and stenting. Periprocedural (≤30 days) risk for clinical (any neurological deterioration) and radiological (new infarction on postprocedural diffusion-weighted imaging) events of stenting in each time interval versus asymptomatic stenosis was calculated with logistic regression analysis adjusted for confounders, and provided as odds ratio (OR) and 95% confidence interval (CI). Results : Overall clinical event rate (4.3%) of stenting for symptomatic carotid stenosis was higher than that for asymptomatic stenosis (1.2%; OR, 3.979 [95% CI, 1.093-14.489]; p=0.036). Stenting in Day 0-3 (13.2%; OR, 10.997 [95% CI, 2.333-51.826]; p=0.002) and Day 4-7 (8.3%; OR, 6.775 [95% CI, 1.382-33.227]; p=0.018) was associated with high risk for clinical events. However, the clinical event rates in stenting after 7 days from index event (Day 8-10, 1.8%; Day 11-14, 2.5%; Day 15-21, 0%; Day >21, 2.9%) were not different from that in stenting for asymptomatic stenosis. Overall radiological event rate (55.6%) in symptomatic stenosis was also higher than that in asymptomatic stenosis (35.5%; OR, 2.274 [95% CI, 1.553-3.352]; p<0.001). The high risk for radiological events was maintained in all time intervals (Day 0-3 : 55.3%; OR, 2.224 [95% CI, 1.103-4.627]; p=0.026; Day 4-7 : 58.3%; OR, 2.543 [95% CI, 1.329-4.949]; p=0.005; Day 8-10 : 53.6%; OR, 2.096 [95% CI, 1.138-3.889]; p=0.018; Day 11-14 : 57.5%; OR, 2.458 [95% CI, 1.225-5.021]; p=0.012; Day 15-21 : 55.6%; OR, 2.271 [95% CI, 1.099-4.764]; p=0.028; Day >21 : 54.8%; OR, 2.203 [95% CI, 1.342-3.641]; p=0.002). Conclusion : This study showed that as stenting was delayed, the periprocedural risk for clinical events decreased. The clinical event risk was high only in stenting within 7 days and comparable with that for asymptomatic stenosis in stenting after 7 days from index event, although the radiological event risk was not affected by stenting timing. Therefore, our results suggest that delayed stenting after 7 days from symptom onset is a safe strategy for symptomatic stenosis.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1111-1118
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• 2018

Background/Aims: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. Methods: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128). Results: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time ($2,618{\pm}381minutes$ vs. $1,739{\pm}241minutes$, p = 0.050), the symptoms-to-balloon time ($3,426{\pm}389minutes$ vs. $2,366{\pm}255minutes$, p = 0.024), and the door-to-balloon time ($2,339{\pm}380minutes$ vs. $1,544{\pm}244minutes$, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487). Conclusions: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.

• 대한중풍순환신경학회지
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• 제23권1호
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• pp.73-84
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• 2022

■Objective The purpose of this case report is to report the effect of Korean medicine treatment on a patient with pontine infarction complaining of discomfort due to aggravated voiding dysfunction after the onset of the stroke. ■Methods The patient was hospitalized for 44 days and treated with herbal medicine, acupuncture, electroacupuncture, moxibustion, and interferential current therapy(ICT). We checked the amount of self-voided volume and postvoid residual urine volume(PVR), and asked the patient to subjectively evaluate the degree of discomfort due to voiding dysfunction. ■Results After 44 days of hospitalization, the patient responded that the subjective discomfort due to residual urine remained 30% and delayed urine remained 50% compared to the day of admission. The maximum amount of PVR was 234 ml on the 3^rd day, and the minimum amount of PVR was checked on 25^th and 35^th day as 0 ml. ■Conclusions This study suggests that Korean medicine treatment may be effective in the treatment of voiding dysfunction after stroke.

• Clinical and Experimental Pediatrics
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• 제54권2호
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• pp.86-89
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• 2011

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

• 고려인삼학회:학술대회논문집
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• 고려인삼학회 1998년도 Advances in Ginseng Research - Proceedings of the 7th International Symposium on Ginseng -
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• pp.21-30
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• 1998

Ginseng root has been considered to prevent neuronal degeneration associated with brain ischemia, but experimental proof in support of this speculation is limited. Moreover, few studies have compared the neuroprotective actions of ginseng ingredients with those of peptide growth factors and cytokines isf vivo. Using a gerbil forebrain ischemia model, we demonstrated that the oral administration of red ginseng powder before an ischemic insult prevents delayed neuronal death in the hippocampal CAI field and that a neuroprotective molecule within red ginseng powder is ginsenoside Rbl. The neurotrophic effect of ginsenoside Rbl, when examined in the gerbil ischemia model and in neuronal cultures was as potent as or more potent than the effects of epidermal growth factor, ciliary neurotrophic factor, erythropoietin, prosaposin, interleukin-6 and interleukin-3. Besides the protection of hippocampal CAI neurons against brain ischemia/repercussion injuries, ginsenoside Rbl was shown to prevent place navigation disability, cortical infarction and secondary thalamic degeneration in stroke-prone spontaneous hypertensive rats with permanent occlusion of the unilateral middle cerebral artery distal to the striate branches. These findings may validate the empirical use of ginseng root for the treatment of cerebrovascular diseases

• Journal of Trauma and Injury
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• 제34권4호
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• pp.294-298
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• 2021

Extrahepatic biliary tract and gallbladder injuries following blunt abdominal trauma are uncommon. Traumatic cystic duct transection is even rarer, which has frequently caused missed diagnosis and delayed treatment. An 18-year-old female patient with no past medical history was transferred to the Trauma Center of Kyungpook National University Hospital after falling from a height of approximately 20 meters. She became hemodynamically stable after initial resuscitation, and initial contrast-enhanced abdominal computed tomography (CT) showed right kidney traumatic infarction and multiple intrahepatic contusions with minimal fluid collection but no extravasation of the contrast. She was admitted to the intensive care unit. On the second day of hospitalization, her abdomen became distended, with follow-up CT showing a large collection of intra-abdominal fluid. Laparoscopic exploration was then performed, which revealed devascularization of the gallbladder with complete transection of the cystic duct and artery. Laparoscopic cholecystectomy was performed, as well as primary closure of the cystic duct orifice on the common bile duct using a 4-0 Prolene suture. After surgery, no clinical evidence of biliary leakage or common bile duct stricture was observed.

• 대한핵의학회지
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• 제32권6호
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• pp.509-515
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• 1998

목적: 관동맥확장 성형술과 같은 재관류술전의 급성심근경색 환자에서 T1-201 부하-재분포 관류 SPECT 영상에서의 역재분포의 빈도를 알아보고 T1-201 재주사 후 섭취증가 여부에 따른 생존심근여부를 좌심실 벽운동의 호전 유무를 관찰하여 임상적의의를 알아보고자 하였다. 대상 및 방법: 급성심근경색으로 입원한 환자 42명을 대상으로 하였으며 T1-201 부하-4시간 재분포-24시간 재주사법에 의한 심근관류 SPECT를 관동맥확장 성형술 전에 시행하였고 좌심실 벽운동의 평가를 위해 심초음파를 SPECT 실시 전에 시행하였다. 또한 좌심실 벽운동 이상의 호전유무를 평가하기 위해 급성심근경색 후 4개월경에 추적관찰을 하였다. 심근관류는 육안적 평가에 의해서 정상을 0, 섭취 없음을 3점으로 4단계 분류하였다. 심근벽의 이상은 정상을 1, 이상운동을 4점으로 5단계 분류하였다. 결과: 42명 환자 전체심근영역 총 672개 영역 중 36개 영역(5%)에서 부하-재분포 영상에서 역재분포가 관찰되었다. 이중 좌심실 벽운동이 심초음파상 이상을 보인 19개영역 중에서 11개가 재주사 후 섭취 증가가 있었고. 이 중 10개 영역(90%)이 심초음파상 좌심실 벽운동이상이 4개월 후에 호전이 있어 생존심근임을 나타냈다. 재주사 후 섭취증가가 없었던 8개 영역 중 5개(62%) 영역은 좌심실 벽운동의 호전이 없었다. 재주사 후 섭취정도에 따라서는 재주사시 정상관류 및 경도관류감소를 보인 10개 영역 중 9개 영역에서 좌심실 벽운동의 호전이 있어 90%의 양성 예측도를 보였다. 중증도 관류감소 및 관류결손을 보인 9개 영역 중 4개 영역은 호전을 5개 영역은 호전이 없어서 56% (5/9)의 음성 예측도를 보였다. 결론: 급성심근경색 후 역재분포를 보인 영역에 T1-201 재주사는 생존심근의 여부를 판단하는데 높은 양성예측도를 갖는 유용한 검사이다.

• 대한한의학방제학회지
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• 제12권2호
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• pp.175-202
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• 2004

Nitric oxide(NO) play an important role in normal and pathophysiological cells including as a messenger molecule, neurotransmitter, microbiocidal agent, or dilator of blood vessels and artheriosclerosis, hypertension, myocardial infarction, respectively. To investigate that Ondamtang in the potential contribution of the levels of nitric oxide generated by endothelial nitric oxide synthase (eNOS) and the mechanisms of protection against L-NAME, human ECV304 cells, which normally do not express eNOS, were expressed by L-NAME. L-NAME stimulated rat or cells were found to be resistant to injury and delayed death following the Ondam-tang. Inhibition of nitric oxide synthesis abolished the protective effect against L-NAME, thrombin and collagen exposure. Interestingly, such effects have bee observed during stimulation with agents such as KCl on L-NAME mediate rats, were damaged by the NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME). Cardiovascular diseases is one of the blood vessels and renin-angiotensin system dynfunction. So we studied on herbal medicine that have a relation of vessels endothelium necrosis. In Oriental Medicine, Ondam-tang has been used for disease in relation to cardiovascular system. We studied on the protection and inhibitory effects of cardiovascular diseases in L-NAME induced rat or ECV304 cell lines through the Cell morphological pattern, Tunel assay, LDH activity, heart rate, blood pressure and immunohistochemistric analysis by Ondam-tang. As the result of this study, In group, the anti-apoptosis and necrosis in the cardiovascular system have a potential capacity for prevented, protected and treating the diseases of cardiovascular system, against the necrosis of rat and ECV304 cells with eNOS and calpain expression by L-NAME is promoted.

• 대한핵의학회지
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• 제34권3호
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• pp.228-233
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• 2000

목적: 역재분포(reverse redistribution)는 심근관류영상에서 초기 thallium 섭취가 정상이거나 정상에 가까운 지역이 재분포 영상에서는 결손으로 보이는 것으로 정의되는데 역재분포의 특성을 더욱 잘 이해하기 위하여 심근조영 심초음파(myocardial contrast echocardiography, MCE)에 의해 진단된 심내막하심근경색과 심근 SPECT 영상에서 관찰되는 역재분포를 연관시켜 분석하였다. 대상및 방법: 급성심근경색으로 진단된 20명의 환자들을 대상으로 경피적 관동맥 성형술로 재혈관화 한 후에 심근조영 심초음파를 시행 한 후 24시간 이내에 심근 SPECT를 시행하였다. 심근조영 심초음파로 미세혈관분포에 대한 조영증강 정도를 세 단계로 평가하였고(1: 정상 조영증강, 0.5: 부분 조영증강, 0: 조영증강 없음) 심내막하경색의 진단은 심외막에만 국한되어 조영이 되고 심내막이 조영되지 않을 경우로 하였다. 심근관류 결손은 4단계(경도, 중등도, 고도, 정상)로 나누었고 24시간 지연영상에서 1단계 이상 나빠지는 경우 역재분포가 존재한다고 판단하였다. 비모수적 Kendall 상관 계수를 SAS 통계 패키지를 이용하여 계산하였다. 결과: 20예 중 15예(75%)가 일치하였다(8예는 양쪽 검사 모두에서 양성, 7예는 음성). 통계 분석상 심근조영심초음파 양성(심내막하 심근경색)인 예와 SPECT 양성(역재분포인 예)인 예의 사이에는 Kendall 상관계수가 0.5025였고 P값이 0.0285였다. 결론: 급성심근경색 환자에서 재혈관화치료 후에 관찰되는 역재분포 소견은 심근조영 심초음파에 보이는 심내막하 심근경색 소견과 유의한 연관이 있었다.

• 대한한방내과학회지
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• 제26권3호
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• pp.575-586
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• 2005

FC(free choresterol) plays an important role in normal and pathophysiological cells including that of messenger molecule or dilator of blood vessels in such illnesses as artheriosclerosis, hypertension and myocardial infarction. Smooth muscle and endothelial cell functions in the arteria wall are unified by complex intercellular signalling processes. In arteria comprised of one layer of smooth muscle cells surrounding the endothelium, the close apposition of the two cell types enables a signal derived from one cell to rapidly diffuse to neighboring cells. Experimentation was conducted to investigate the potential contribution of Sohaphyangwon(SHHW) on levels of FC generated by goaded microphages, and mechanisms of protection against ACAT inhibitor. It was found that J774 macrophages, which normally do not express FC were expressed by oxLDL and ACAT inhibitor. SHHW protected cells were found to be resistant to oxLDL and delayed death following the FC. Inhibition of FC formation abolished the protective effect against ACAT inhibitor exposure. Cadiovascular diseases include abnormalities of blood vessels dysfunction of the renin-angiotension system. What relation herbal medicine may have with vessel endothelium necrosis was here studied. In Oriental Medicine, SHHW water extract used for diseases in relation to cardiovascular systems. The resistence to cardiovascular disease of ACAT inhibitor induced J774 macrophage cells were studied through analysis of cell morphological patterns and immunochemistry of SHHW. The results of this study suggest that SHHW has protective effects on the cardiovascular system, and that it is effective in both prevention and treatment of diseases of the cardiovascular system, particularity against necrosis of blood.