• Tuberculosis and Respiratory Diseases
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• v.77 no.3
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• pp.105-110
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• 2014

Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is an important cause of morbidity and mortality. The aim of this review is to summarize the findings from clinically important publications over the last year in the area of VTE. In this review, we discuss 11 randomized controlled trials published from March 2013 to April 2014. The COAG and the EU-PACT trials indicate that pharmacogenetic testing has either no usefulness in the initial dosing of vitamin K antagonists or marginal usefulness in the Caucasian population. Recent clinical trials with novel oral anticoagulants (NOACs) have demonstrated that the efficacy and safety of rivaroxaban, apixaban, edoxaban, and dabigatran are not inferior to those of conventional anticoagulants for the treatment of VTE. The PEITHO and ULTIMA trials suggested that rescue thrombolysis or catheter-directed thrombolysis may maximize the clinical benefits and minimize the bleeding risk. Lastly, riociguat has a proven efficacy in treating chronic thromboembolic pulmonary hypertension. In the future, NOACs, riociguat, and catheter-directed thrombolysis have the potential to revolutionize the management of patients with VTE.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.392-396
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• 2016

We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.300-302
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• 2006

"Stunning" represents prolonged contractile depression of any muscular component after alleviation of severe ischemia, as shown in reperfusion following acute myocardial ischemia or ischemic stroke. Clinically, it presents with no or delayed recovery past to thrombolytic therapy but its pathogenic mechanism is not fully uncovered yet. We describe a unique case of a 63-year-old woman, who was undertaken endovascular coiling for the aneurysms, deteriorated several hours later without known cause, and showed delayed clinical improvement over the next 3 days following thrombolysis. Immediate post-thrombolysis magnetic resonance imaging scan showed no apparent abnormality except for high signal intensity within the corresponding hemisphere. Reversible but delayed nature of " brain stunning" can be explained by these images and it seems to be caused by a certain type of reperfusion injury.

• Tuberculosis and Respiratory Diseases
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• v.59 no.5
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• pp.487-496
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• 2005

Background : 'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. Methods : In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. Results : A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHEII and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). Conclusion: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.185-189
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• 2008

Objective : The authors present their experiences with stereotactic multiplanar reformatted (MPR) computed tomography (CT)-guided catheter placement for thrombolysis of spontaneous intracerebral hematoma (sICH) and their clinical results. Methods : In 23 patients with sICH, MPR CT-guided catheter placement was used to select the trajectory and target point of hematoma drainage. This group was comprised of 11 men and 12 women, and the mean age was 57.5 years (range, 31-79 years). The patients' initial Glasgow Coma Scale scores ranged from 7 to 15 with a median of 11. The volume of the hematoma ranged from 24 mL to 86 mL (mean 44.5 mL). A trajectory along the main axis of the hematoma was considered to be optimal for thrombolytic therapy. The trajectory was calculated from the point of entry through the target point of the hematoma using reformatted images. Results : The hematoma catheter was left in place for a median duration of 48.9 hours (range 34 to 62 hours). In an average of two days, the average residual hematoma volume was 6.2 mL (range 1.4 mL to 10.2 mL) and was reduced by an average of 84.7% (range 71.6% to 96.3%). The residual hematoma at postoperative seven days was less than 5 mL in all patients. There was no treatment-related death during hospitalization. Conclusion : The present study indicates that stereotactic MPR CT-guided catheter placement for thrombolysis is an accurate and safe procedure. We suggest that this procedure for stereotactic removal of sICH should be considered for the optimization of the trajectory selection in the future.

• Proceedings of the KIEE Conference
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• 2006.07c
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• pp.1631-1632
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• 2006

This paper reports on a flexible and biocompatible platinum thermoresistive temperature sensor for the application of an ultrasonic resonance thrombolysis device for ischemic stroke. The proposed flexible platinum temperature sensor consists of a polyimide substrate, a platinum thermoresistive element and a polyimide insulation layer. The temperature coefficient of resistance (TCR) and sensitivity of the designed temperature sensor were measured and calculated to be $2.63{\times}10^{-3}/^{\circ}C$ and $0.93^{\circ}C/sec$, respectively.

• Journal of Biomedical Engineering Research
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• v.27 no.5
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• pp.267-273
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• 2006

Numerical analysis was performed on the enzyme transport and the flow fields in order to predict the effectiveness of urokinase injection regimens in clot dissolution. The species and momentum transport equations were numerically solved for the case of uniform perfusion of enzyme into a fibrin clot for an arterial thrombus and a deep vein thrombus models. In order to predict the thrombus lysis efficiency of continuous and forced intermittent injections, enzyme perfusion and clot lysis were simulated for the different injection velocities. Intermittent injection showed faster clot lysis compared to continuous perfusion, and lysis efficiency was increased as injection velocity increased.

• The Korean Journal of Nuclear Medicine
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• v.18 no.2
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• pp.39-45
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• 1984

Investigating LVF directly, quantitatively and non-invasively by MUGA helps to validate and to follow up the effectiveness of new kinds of therapy. This is performed in controlled studies comparing groups of patients as demonstrated in the case of intracoronary thrombolysis. But it is also applicable on an individual basis. Contrary to the protocol in controlled studies medication was not discontinued in our patients before and after bypass surgery. This resembles the situation under routine conditions. Therefore the number of patients with reduced LVF was rather small before and after bypass operation. But, and this in the main result of our study, implementing MUGA for follow-up under this conditions can help: 1. To find out early those patients in whom LVF deteriorates postoperatively despite adequate medication. 2. To better define whether in cases of persistent or recurrent angina there is also deterioration of LVF. By this means MUGA can significantly contribute to find out whether reangiography is necessary or not, a question which often is difficult to answer in those patients.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.262-267
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• 2012

Objective : We aimed to investigate the correlation between the success of recanalization and a modified version of the Qureshi grading system in acute ischemic stroke patients. Methods : We retrospectively analyzed the intra-arterial thrombolysis (IAT) records of 37 patients who were evaluated by Thrombolysis in Myocardial Infarction (TIMI) and a modified version of the Qureshi grading systems as follows : 1) post-IAT Qureshi grade, 2) modified ${\Delta}$ Qureshi grade : pre-IAT group grade - post-IAT group grade (grade 1 : Qureshi grades 0-2 and grade 2 : Qureshi grade 3-5) and 3) ${\Delta}$ Qureshi grade (post-IAT Qureshi grade - pre-IAT Qureshi grade). Successful recanalization was defined as follows : 1) post-IAT TIMI grades 2 and 3, 2) post-IAT Qureshi grade 0-2, 3) modified ${\Delta}$ Qureshi grade=1, and 4) ${\Delta}$ Qureshi grade of ${\geq}2$ and/or post-IAT Qureshi grade=0. We investigated the correlation between the post-IAT TIMI grade and the modified Qureshi grade and also compared the various grading systems with modified Rankin Scale scores for evaluating the clinical outcome at 3 months. Results : The post-IAT Qureshi grade and ${\Delta}$ Qureshi grade and/or post-IAT Qureshi grade were significantly correlated with the TIMI grade (${\gamma}$=0.976 and, 0.942, respectively). Further, post-IAT Qureshi grade and ${\Delta}$ Qureshi grade and/or post-IAT Qureshi grade showed a significantly stronger association with clinical outcome than did the post-IAT TIMI grade (p=0.001 and, 0.000 vs. 0.083, respectively). Conclusion : Our preliminary results suggest that the modified Qureshi grading system is a useful tool for assessing the success of recanalization after IAT.

• Journal of Korean Neurosurgical Society
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• v.30 no.1
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• pp.99-104
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• 2001

We present two cases of deep cerebral venous thrombosis(DCVT) with the totally occluded straight sinus. A 42-year-old female received with altered mentality . She has taken antihistamine for six years to treat the paranasal sinusitis. Another 34-year-old female who used the oral contraceptive for 11 months presented with acute behavior change . Both of these patients were diagnosed by computed tomography(CT), magnetic resonance(MR) imaging, and cerebral angiography. They were fully recovered with systemic urokinase thrombolysis followed by heparin therapy. We report that the intravenous thrombolysis was potentially effective management strategy in our cases of DCVT with the totally occluded straight sinus.