• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.117-121
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• 2016

Objective : Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. Methods : This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. Results : Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate $5.8{\pm}1.4%/year$). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). Conclusion : Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.

• 대한통합의학회지
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• 제5권4호
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• pp.103-112
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• 2017

Purpose : This study was conducted to improve cognitive oral healthcare care by analyzing the correlation between oral health behavior and oral health status Korean adolescents. The subjects were 65,528 youths in 798 schools monitored in the Twelfth Korea Youth Risk Behavior Web-based Survey in 2016. Methods : The general characteristics consisted of 9 items including sex, grade, and academic performance. The academic performance and economic status were restructured into "upper, middle, lower". Subjective health perception and subjective oral health perception were reorganized as "health", "normal", "no health". The sub-areas of oral health behavior include five times of daily brushing during the day yesterday. The number of brushing times was "0", "1-2", "3", "more than 4" After lunch at school, brushing was restructured as "always," "sometimes," "not." The oral health status subscale consisted of 6 items including tooth breakage and toothache at the time of eating. Result : Tooth fracture(43.7 %), pain in mastication(43.7 %), tooth tingling(47.4 %), gum pain and bleeding(45 %), pain in buccal mucosa(43.8 %) and halitosis(46.6 %) were rare in adolescent having healthy oral health status cognitively(P<.001). Nosymptom adolescents without dental sealant showed low tooth fracture(0.64 times), pain in mastication(0.67 times), tooth tingling(0.59 times), gum pain and bleeding(0.84 times), pain in buccal mucosa(0.76 times), and halitosis(0.90 times). Nosymptom adolescents without scaling showed low tooth fracture(0.88 times), pain in mastication(1.03 times), tooth tingling(0.82 times), gum pain and bleeding(0.64 times), pain in buccal mucosa(0.70 times) and halitosis(0.82 times). Conclusion : This study revealed that oral health status is correlated with oral health behavior. Development of educational media and program, and aggressive promotion required to establish oral health Korean adolescent.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.1015-1021
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• 2014

This study aimed at summarizing published study findings on the diagnostic value of rectal bleeding (RB) and informing clinical practice, preventive interventions and future research areas. We searched Medline and Embase for studies published by September 13, 2013 examining the risk of colorectal cancer in patients with RB using highly inclusive algorithms. Data for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive predictive value (PPV) of RB were extracted by two researchers and analyzed applying Meta-Disc (version 1.4) and Stata (version 11.0). Methodological quality of studies was assessed according to QUADAS. A total of 38 studies containing 5,626 colorectal cancer patients and 73,174 participants with RB were included. The pooled sensitivity and specificity were 0.47 (95% CI: 0.45-0.48) and 0.96 (95% CI: 0.96-0.96) respectively. The overall PPVs ranged from 0.01 to 0.21 with a pooled value of 0.06 (95% CI: 0.05-0.08). Being over the age of 60 years, change in bowel habit, weight loss, anaemia, colorectal cancer among first-degree relatives and feeling of incomplete evacuation of rectum appeared to increase the predictive value of RB. Although RB greatly increases the probability of diagnosing colorectal cancer, it alone may not be sufficient for proposing further sophisticated investigations. However, given the high specificity, subjects without RB may be ruled out of further investigations. Future studies should focus on strategies using RB as an "alarm" symptom and finding additional indications to justify whether there is a need for further investigations.

• 성인간호학회지
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• 제14권2호
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• pp.222-232
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• 2002

Background and Purpose: After the coronary angiography procedure, patients are required to remain on bed rest to reduce the risk of bleeding and hematoma formation at the puncture site. This prolonged bed rest in the supine position is difficult for many patients, who frequently complain of low back pain. The purpose of the study was to determine whether a specially designed exercise therapy and transcutaneous electrical nerve stimulation (TENS) had an effect on the alleviation of low back pain. Method: Sixty-two patients were assigned to one of three groups : specially designed exercise therapy plus TENS plus general nursing care (exercise group N=21), general nursing care plus TENS (TENS group, N=23) or general nursing care (control group, N=18). The exercise therapy consisted of five movements including stretching, pelvic tilting, knee to chest, modified situps and trunk rotation with minimizing the motion of the puncture site. The severity of low back pain was assessed by a visual analogue scale(VAS) every two hours. The use of analgesic and any development of bleeding or other complications were monitored as well. The level of serum ${\beta}$-endorphin was determined before and after the three interventions. Result: The pain score of the exercise group was significantly lowered compared to that of the other groups. There was no difference in the serum ${\beta}$-endorphin level among three groups. Analgesic were less frequently taken by the exercise group. However the incidence of bleeding complications was not significantly different among the three groups. Conclusion: Exercise therapy is more effective than general care or TENS in alleviating low back pain of the patients with coronary angiography.

• Journal of Chest Surgery
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• 제25권2호
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• pp.149-157
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• 1992

Total 145 cases mitral vlave replacement were performed in Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from May 1983 to July 1991. Sixty-one patients were male and 84 patients were female and the range of age was from 12 to 66 years old with the mean of 37.9[$\pm$11.6] years. Valvular lesions were 49 cases of mitral stenosis, 18 cases of regurgitation and 78 cases of combined lesion. Used valve were Ionescu-Shiley[42 cases], Bjork-Shiley[49 cases], Inact[6 cases], St. Jude Medical[11 cases] and CarboMedics[37 cases]. Mean size of valve was 29.8$\pm$1.68mm. Early morality was 13.8%[20 cases] and low output syndrome was most common cause[9 cases]. Age, functional classification and biventricular hypertrophy were risk factors. All survived cases were followed up without missing. Mean follow up period were 3 years and 3 months. Total 14 cases of death[9.7%] were observed and heart failure, unexplained sudden death and bleeding were the causes in that order. Common late complications were heart failure and bleeding related with anticoagulation. Actuarial survival rate at 5 years was 83$\pm$5.4% in overall, 78$\pm$7.2% in tissue valve group, 87$\pm$6.8% in mechanical valve group. The actuarial freedom rate from thromboembolism at 7 years was 89$\pm$8.3% in overall, 86$\pm$9.9% in tissue valve group and 97$\pm$1.9% in mechanical valve group. Actuarial freedom rate from bleeding at 5 years with anticoagulation was 88.9$\pm$4.2% in overall, 96$\pm$3.9% in tissue valve group, 86$\pm$4.6% in mechanical valve group. Reoperation was done in 3 cases with heart failure with tricuspid regurgitation and thromboembolism in 2 cases. The functional status of survived cases was I or II.

• 대한소아치과학회지
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• 제32권4호
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• pp.589-594
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• 2005

혈우병은 성염색체 열성 유전양식에 따라 유전되는 출혈성 질환으로서 응고인자의 결핍이나 결손에 의해 혈액응고 시간이 지연되게 된다. 과거에는 혈우병 환자의 치과치료시 과다출혈의 위험성 때문에 치과시술을 위해서는 입원하여 내과 전문의나 혈액 전문의가 출혈을 조절하도록 하여 치료하는 것이 바람직한 것으로 여겨졌으나, 최근의 혈액응고기전에 대한 이해와 의료기술 발전에 의해 출혈을 좀더 효과적으로 조절할 수 있게 되었다. 본과에 내원한 혈우병 B, 중증과 혈우병 A, 중증에 해당하는 환아에서의 관혈적인 치과치료를 시행하여 각각의 과정 및 치료원칙에 관하여 다음과 같이 보고하는 바이다. 1 혈우병 환자의 치료시에는 반드시 환자의 내과 소아과 또는 혈액 전문의와 상의하여 긴밀한 협조하에 치과 치료를 시행하도록 한다. 2. 환자의 치료방법은 환자의 전신상태와 협조도 및, 필요한 시술의 위험성 정도에 따라 결정하도록 한다. 3. 치과치료의 전과 후에 혈액응고인자의 투여 등으로 발생하는 불편과 합병증의 기회를 최소로 하기 위해 치료를 위한 내원 횟수를 가능한 한 줄여주는 것이 바람직하며, 치료 시에는 감염을 예방하고 지혈을 도울 수 있는 치료를 시행해야 한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권6호
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• pp.343-350
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• 2019

Objectives: The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required. Materials and Methods: Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage. Results: The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001). Conclusion: A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.

• Clinical and Experimental Reproductive Medicine
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• 제39권4호
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• pp.187-192
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• 2012

Heterotopic pregnancy is rare event and the risk is increased with assisted reproductive technology procedures. Heterotopic cervical pregnancy is even more unusual. We report a rare case of heterotopic cervical pregnancy that was managed successfully. A 36-year-old women who conceived by IVF-ICSI was diagnosed with heterotopic cervical pregnancy. She visited the emergency room with vaginal bleeding at 5 weeks of gestation and underwent careful intracervical gestational sac reduction with forceps under abdominal guidance the next day. The postoperative course was uneventful and with regular check-ups, the intrauterine pregnancy (IUP) progressed unremarkably through 41 weeks with delivery of a healthy newborn. We reviewed a total of 37 cases of heterotopic pregnancy that have been reported in the English language literature. There have been many attempts to eliminate the cervical embryo while preserving the IUP, and complete cervical evacuation is important in order to avoid infection, bleeding, and premature birth.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제16권1호
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• pp.53-60
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• 2013

In Crohn's disease, mild gastrointestinal bleeding often occurs; however massive gastrointestinal hemorrhage, which can have a dramatic effect on a patient's vital sign, is rare. This could result in potentially life-threatening complications, which can lead to death. Massive hemorrhagic Crohn's disease is not well known and for this reason, they are a diagnostic and therapeutic challenge. Various diagnostic and therapeutic methods are currently being developed and used. The surgical method is often used only as a last measure since this approach has the risk of serious complications that may endanger patients. However, if massive bleeding continues even after all therapeutic methods are used, the surgical method must be implemented. In this case, all therapeutic methods were found to be ineffective; therefore, surgery was used as a last option. Ultimately, the surgical method was found to be successfully used to treat life-threatening hemorrhagic Crohn's disease.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1346-1353
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• 1992

From Febrary 1984 to July 1992, 138 cases of multiple valve replacements were performed at the Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University. There were 81 females and 57 males, and their ages ranged from 19 to 60 years [mean age, 40.1$\pm$10.9 years]. Thirteen of these patients had undergone previous cardiovascular procedures, with an average of 76.3 months between procedures[range, 3 to 180 months]. Mitral and aortic valve replacement were done in 135 patients, 2 underwent triple valve replacement and 1 underwent mitral and tricuspid valve replacement. Associated procedures were necessary in 20 patients[14.5%]. The operative mortality was 5.8% and the most common cause was low cardiac output. Late follow-up of 83% has been accomplished in 130 early survivors, with a late mortality of 5.9%. The late mortality was due to valve thrombosis in 2 patients, cerebral infarction in 1, heart failure in 1, arrhythmia in 1, and bleeding in l. Of those patients who survived, New York Heart Association functional class improved significantly[from 70% class III and IV before to 88% class I and II after]. Actuarial survival rate including all deaths was 88.8% at 8 years. The follow-up studies revealed that thromboembolism, reoperation and bleeding rate were 1.2%/patient-year, 0.85% /patient-year and 0.57%/patient-year at 8 years postoperatively. We concluded that valve thrombosis, embolism, and anticoagulant-related hemorrhage were the main risk factors of longterm survival of patients.