• Tuberculosis and Respiratory Diseases
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• 제67권4호
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• pp.351-355
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• 2009

The incidence of pulmonary thromboembolism increases with age. The risk factors of pulmonary thromboembolism include surgery, malignancy, obesity, lupus anticoagulants, and vascular conditions such as deep vein thrombosis. Thromboembolism in younger patients or in unusual locations, the possibility of primary thrombophilic conditions should be considered. Primary thrombophilic states include myeloproliferative disorders (MPD). JAK2 V617F mutation is found commonly in patients diagnosed with MPD, in 90~95% of polycythemia vera (PV) and in 50~60% of essential thrombocytosis (ET) patients. Sometimes the JAK2 V617F mutation is found in cases without MPD. The relationship between JAK2 V617F mutation and thrombosis has not been defined. Recently, clinical evidence suggests that this mutation may be variably associated with thrombosis. We present one case of pulmonary thromboembolism in a young patient, who was positive for the JAK2 V617F mutation and did not have MPD.

• 대한두개안면성형외과학회지
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• 제14권2호
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• pp.133-136
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• 2013

Retrobulbar hemorrhage is a rare but serious complication after blepharoplasty, mid-face injury, and treatment of facial bone fractures. The incidence of postoperative retrobulbar hemorrhage is 0.055% with an incidence of associated permanent blindness of 0.005%. A 69-year-old male came to the emergency room with pain on both orbital areas and uncontrolled bleeding after cosmetic lower blepharoplasty performed at a private clinic. He had not been evaluated preoperatively by the private clinic, but we found that he had undergone percutaneous transluminal coronary angioplasty and taken anticoagulants for 10 years. We performed an emergency operation to evacuate the hematoma. However, after surgery, he persistently complained of orbital pain, pressure and diminished visual acuity. Intraocular pressure was increased, and computed tomography demonstrated a retrobulbar hemorrhage with globe displacement. Emergent lateral canthotomy and cantholysis were performed. Intraocular pressure was decreased to 48/30 mm Hg immediately after the operation, falling within the normal range the next day. We recommend three points to minimize loss of vision by retrobulbar hematoma. Firstly, careful preoperative evaluation must be conducted including current medications, underlying diseases and previous history of surgeries. Secondly, cautious postoperative observation is important for the early diagnosis of retrobulbar hematoma. Lastly, immediate treatment is crucial to prevent permanent blindness.

• 대한수의학회지
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• 제32권3호
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• pp.421-427
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• 1992

The study was basically carried out to establish the appropriate condition for applying the Westergren method for erythrocyte sedimentation rate(W-ESR) in Throughbred racehorses at recess. To do this, we examined the correlationship among some factors including the kind of anticoagulants, optimal ambient temperature and reading time for W-ESR in healthy racehorses. The difference between the blood samples treated with only 3.8% solution of sodium citrate(SC) and both EDTA and SC as a coagulant, there was not recognized any significant difference(p<0.05) in the levels of W-ESR irrespective of the ambient temperature of $20^{\circ}C$ or $30^{\circ}C$. The best optimal ambient temperature for W-ESR in horses was proved at $30^{\circ}C$ resulting from the tendency of the most reduced dispersion in mean values analyaed from repeatly 4 times to the same blood samles compared with those of $10^{\circ}C$ and $20^{\circ}C$. The optimal reading time was determined as 60 minutes(Y=237.2~4.1X, $r^2=0.998$) and 70 minutes(Y=247.8~4.2X, $r^2=0.999$) under the same temperature of $30^{\circ}C$; the latter showed the better result on the basis of the correlation of packed cell volume(PCV) and ESR values. About 13 healthy racehorses, we compared the real values of W-ESR respectively obtained at 60 minutes and 70 minutes at $30^{\circ}C$ with the anticipated values of PCV by means of the analysis of linear regression equitation. As the result of this, the strong correlation between both of them was confirmed. For practical use of W-ESR in Thoroughbred racehorese, we can recommend the condition of 60 or 70 minutes for the optimal reading time as well as $30^{\circ}C$ for the best ambient temperature.

• Journal of Chest Surgery
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• 제42권3호
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• pp.371-374
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• 2009

36세의 여자환자가 복부통증 및 하지부종소견을 주소로 내원하였다. 과거력상 자연유산의 경험이 있고 광과민성, 수관절 통증을 간헐적으로 호소하였으며, 입원당시 시행한 컴퓨터 단층촬영상 하대정맥에 혈전이 관찰되었으며, 혈액검사상 자가항체의 상승이 동반되어 인지질항체 증후군으로 진단되었다. 헤파린 및 이뇨제등의 약물치료를 유지하는 동안 폐동맥색전증이 관찰되어 혈전제거 술을 시행하였으며 현재 환자는 특별한 재발의 소견 없이 항응고요법을 시행하며 외래에서 추적관찰중이다.

• Journal of Chest Surgery
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• 제18권3호
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• pp.446-455
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• 1985

A total and consecutive 156 patients have undergone cardiac valve surgery including 13 closed mitral commissurotomy, 13 open mitral commissurotomy, one mitral annuloplasty, 75 mitral valve replacement, one aortic annuloplasty, 24 aortic valve replacement, 3 tricuspid valve replacement, 25 double valve replacement and one triple valve replacement. 155 prosthetic valves were replaced in a period between September 1976 and August 1985. There were 68 males and 88 females with age range from 8 to 69 yrs [mean 36.5 yr]. Out of replaced valves, 61 was tissue valve including 54 Carpentier-Edwards, and 4 was mechanical valves including 74 St. Jude Medical, and the position replaced was 101 valves for mitral, 46 for aortic and 8 for tricuspid. Single valve replacement in 102 cases, double valve replacement in 25 cases [17 for AVR+MVR, and 8 for MVR+TVR], and only one case was noted in the triple valve replacement. Early mortality within 30 days after operation was noted in 11 cases [7%]; 7 after MVR, 2 after DVR, and each one after open mitral commissurotomy and mitral annuloplasty. Cause of death was valve thrombus, cerebral air embolism, low output syndrome, uncontrollable arrhythmia, parapneumonic sepsis, acute cardiac tamponade and left atrial rupture. 7 late deaths were noted during the follow-up period from 1 to 104 months [average 48 month]; three due to valve and left atrial thrombus formation, two due to CVA from overdose of warfarin, and each one due to congestive heart failure and chronic constrictive pericarditis, Anticoagulants after prosthetic valve replacement were maintained with warfarin, dipyridamole and aspirin to the level of around 50% of normal prothrombin time in 79 cases, and Ticlopidine with aspirin in 47 cases to compare the result of each group. There were 11 major thromboembolic episodes including 3 deaths in the warfarin group. Two cases of CVA due to overdose of warfarin was noted in the warfarin group. In the ticlopidine group, there was only one left atrial thrombus confirmed at the time of autopsy. Among the survived 138 cases, nearly all cases[136 cases] were included in NYHA functional class I and II during the follow-up period. In conclusion, surgical treatment of the cardiac valve disease in 156 clinical cases revealed excellent result with acceptable operative risk and late mortality. Prevention of thrombus formation with anti-platelet aggregator Ticlopidine has better result than warfarin group presently with no specific side effect such as bleeding or gastrointestinal trouble.

• Journal of Chest Surgery
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• 제20권1호
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• pp.13-21
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• 1987

To clarify the difference between the outcome of warfarin anticoagulation and the antiplatelet [Aspirin, Dipyridamole] therapy after bioprosthetic heart valve replacement, we compared the following two groups. Group I [Warfarin group] consisted of 557 patients undergone lonescu - Shiley valve replacement between January, 1979 and December, 1985, and treated with scheduled warfarin therapy at Seoul National University Hospital. Group II [Antiplatelet group] consisted of 128 patients undergone lonescu - Shiley, Carpentier - Edwards or Wessex bioprosthetic valve replacement between March, 1983 and December, 1986, and treated primarily with antiplatelet therapy [Aspirin plus Dipyridamole] at SeJong General Hospital. The two groups were similar with respect to age, number of valves utilized per patient, type of operation and risk factors of thromboembolism. In group I, 522 patients excluding 35 hospital death [hospital mortality 6.3%], and in group II, 119 survivors excluding 9 hospital death [hospital mortality 7.0%] were followed. In group I, there were 13 fatal complications, of which seven were thromboembolic [0.6% / pt-yr] and six hemorrhagic [0.5%/pt-yr] during the period of four years. In group II, there were 3 fatal thromboembolic complications [2.3%/pt-yr] during the period of four years. This showed no statistically significant difference. Apart from fatal complications, there were lots of warfarin related minor complications in group I comparing with those of group II. The actuarial probability of the freedom from thromboembolism and of the freedom from fatal complications were very similar at each corresponding years postoperatively. As a result, warfarin anticoagulation in patients with bioprosthetic valve replacement did not reveal any significant advantages over antiplatelet therapy.

• Journal of Microbiology and Biotechnology
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• 제28권2호
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• pp.275-283
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• 2018

Ischemic stroke can result from blockage of blood vessels, forming fibrin clots in the body and causing irreparable brain damage. Remedial thrombolytic agents or anticoagulants have been studied; however, because the FDA-approved tissue plasminogen activator has low efficacy and side effects, it is necessary to develop safer and more effective treatment candidates. This study aimed at assessing the fibrinolytic and anticoagulation features of a novel serine protease extracted and purified from Diopatra sugokai, a polychaeta that inhabits tidal flats. The purified serine protease was obtained through ammonium sulfate precipitation, affinity chromatography, and ion-exchange chromatography. Its molecular size was identified via SDS-PAGE. To characterize its enzymatic activities, the protease activity at various pH and temperatures, and in the presence of various inhibitors, was measured via azocasein assay. Its fibrinolytic activity and anticoagulant effect were assessed by fibrin zymography, fibrin plate assay, and fibrinogenolytic activity assays. The novel 38 kDa serine protease had strong indirect thrombolytic activity rather than direct activity over broad pH (4-10) and temperature ($37^{\circ}C-70^{\circ}C$) ranges. In addition, the novel serine protease exhibited anticoagulant activity by degrading the ${\alpha}$-, ${\beta}$-, and ${\gamma}$-chains of fibrinogen. In addition, it did not produce cytotoxicity in endothelial cells. Therefore, this newly isolated serine protease is worthy of further investigation as a novel alkaline serine protease for thrombolytic therapy against brain ischemia.

• 한국임상약학회지
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• 제26권3호
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• pp.207-212
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• 2016

Objective: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). Methods: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). Results: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ${\geq}3$ (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. Conclusion: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.

• Journal of Chest Surgery
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• 제42권5호
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• pp.657-661
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• 2009

점막하 식도 박리는 드문 질환으로 식도 천공 없이 점막하 출혈 및 혈종에 의해 점막하층과 근육층이 박리되는 상태를 의미하며, Mallory-Weiss, Boerhaave's syndrome과 함께 제3의 급성 식도 손상질환이다. 금식과 수액 요법 등의 보존적 치료만으로도 비교적 예후가 좋다. 하지만 출혈 소인이 있는 질환이나 정상적인 지혈에 영향을 미치는 약제(anticoagulants, anti-platelets, thrombolytic agents)를 복용중인 환자에서, 흉통 및 연하통 혹은 연하곤란 등을 호소하는 경우에 감별 진단으로 염두에 두어야 부적절한 치료를 피할 수 있다. 본 증례는 항혈소판 제재를 복용 중에 발생한 점막하 식도 박리를 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.523-527
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• 2012

Objective : The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. Methods : We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. Results : Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. Conclusion : For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.