• Title/Summary/Keyword: cerebrovascular

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A Study on Years of Potential Life Lost in Korea - Focus on Alcohol - (우리 나라 잠재수명 손실년수에 관한 연구)

  • Jo, Jeanman;Lim, Dar-Oh
    • The Korean Journal of Emergency Medical Services
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    • v.3 no.1
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    • pp.65-76
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    • 1999
  • Objectives: This study sought to examine the impact of alcohol use and misuse on mortality in korea during the 1991-l997. Methods: Alcohol-Related Disease Impact estimation software and Korea vital statistics data were used to calculate alcohol related-mortality, mortality rates, and YPLL(years of potential life lost). The major findings are as follows : An estimated 23,528 Korean died during 1997 from causes related to alcohol. Such deaths accounted for 17,052(12.60%) of all deaths for men and 6,206(5.88%) for women. Motor vehicle accidents were major contributors to the total estimated number of alcohol related deaths and years of potential life lost before age 65. Alcohol related mortality rates were significantly higher for men. For men, major causes of the deaths were motor vehicle accidents(4,147 deaths, 17.90 per 100,000 population), cancer of the stomach(1,467 deaths, 16.60 per 100,000 population) and chronic liver diseases and cirrhosis(1,233 deaths, 13.10). For women, the largest contributors to alcohol related mortality were motor vehicle accidents(1,509 deaths, 6.61), cerebrovascular diseases(1,114 deaths, 11.3) and cancer of the stomach(810 deaths, 8.24). Kleinman's method was used for obtaining on regional(Dongs, ups and Myons) differential of the alcohol related mortality in 1995. In general, The alcohol-related death rate for men was significantly higher than that for women, and the rate for ups and myons was significantly higher than that for dongs During 1997, approximately 356,667(male: 282, 510, female: 74, 157)YPLL to age 65 and 572,708(male:424,338, female:148,370)YPLL to life expectancy were attributable to alcohol related causes. Men accounted for 79% of the total YPLL to age 65 and 74% of the total YPLL to life expectancy The major contributors to these alcohol related years lost were the diagnostic categories of unintentional injuries. Particullary, In male, Motor vehicle accidents and accidental drowning-YPLL are considerably higher for other causes. Male-female YPLL differentials were greatest for mental disorder. Male-female mean-YPLL to age 65, accidental drowning(male;36.47, female;37.67) is higher for other causes. In both sexes, The YPLL and M-YPLL to life expectancy was significantly higher than the YPLL and M-YPLL to life expectancy.

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Early Postoperative Complications after Heart Transplantation in Adult Recipients: Asan Medical Center Experience

  • Kim, Ho Jin;Jung, Sung-Ho;Kim, Jae Joong;Kim, Joon Bum;Choo, Suk Jung;Yun, Tae-Jin;Chung, Cheol Hyun;Lee, Jae Won
    • Journal of Chest Surgery
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    • v.46 no.6
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    • pp.426-432
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    • 2013
  • Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

Development and Analysis of Community Based Independent Home Care Nursing Service (지역사회중심의 독립형 가정간호 시범사업소 운영체계 개발 및 운영결과 분석)

  • Park, Jung-Ho;Kim, Mae-Ja;Hong, Kyung-Ja;Han, Kyung-Ja;Park, Sung-Ae;Yun, Soon-Nyoung;Lee, In-Sook;Cho, Hyun;Bang, Kyung-Sook
    • Journal of Korean Academy of Nursing
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    • v.30 no.6
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    • pp.1455-1466
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    • 2000
  • The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.

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Factors Related to the Disability of Stroke Patients in Gyeongju, Korea (경주지역 뇌졸중 환자들의 장애정도와 관련요인)

  • Kang, Min-Soo;Jo, Min-Woo;Lim, Hyun-Sul;Kim, Sang-Kyu
    • Journal of agricultural medicine and community health
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    • v.35 no.4
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    • pp.405-416
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    • 2010
  • Objectives: This study was conducted to evaluate factors related to the degree of disability of stroke patients in a rural community. Methods: The study subjects included 641 patients selected from 975 stroke patients over the age of 50 with brain lesion-related disabilities living in Gyeongju, Korea, an urban-rural consolidated community. The data were obtained by interviews from July to October 2008. The subjects were divided into a seriously disabled group (1st and 2nd disability grade) and mildly disabled group (3th, 4th, 5th and 6th disability grade) by degree of disability according to registered disability grade. The collected data were analyzed using the SPSS 14.0 statistical package. Results: The study subjects included 379 males (59.1%) and 262 females (40.9%), and most patients were in their 70s (256 cases, 39.9%). The seriously disabled group included 287 patients (44.8%) and the mildly disabled group included 354 persons (55.2%). Age, prehospital delayed time and number of related chronic diseases were risk factors for serious disability (p<0.05). Conclusions: Our results indicate that the degree of disability can be reduced by decreasing prehospital delayed time. We suggest that education of high risk groups and establishment of emergency services as well as a transport system for stroke patients are required to reduce the degree of disability due to stroke.

A Retrospective Study on the Effect of 1-Year Clozapine Administration on Platelet Activity in Patients with Schizophrenia or Schizoaffective Disorder (조현병/조현정동장애 환자에서 1년간의 Clozapine 투여가 혈소판 활성도에 미치는 영향에 관한 후향적 연구)

  • Jang, EunJa;Lee, Jong Wook;Kim, Seung-Jun;Oh, Hong-Seok;Im, Woo Young;Lee, Na-Hyun;Kim, Ji-Woong
    • Korean Journal of Psychosomatic Medicine
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    • v.28 no.1
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    • pp.36-41
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    • 2020
  • Objectives : Clozapine has been known to increase the possibility of developing cardio/cerebrovascular diseases, and the platelet activation has been deemed to be related to the occurrence of them. In author's previous study, we observed the increase of platelet activity with short-term clozapine administration. This study was conducted, as a follow-up study, to investigate the effect of clozapine on the platelet activity when administered continuously for long-term period of time of 1 year. Methods : The medical records of the patients with schizophrenia or schizoaffective disorder who were treated with clozapine for 1 year were retrospectively reviewed. The degree of platelet activation was assessed by measuring the mean platelet component. Results : Total of 24 patients were enrolled. 9 of them (37.5%) were male and 15 of them (62.5%) were female. In the Wilcoxon sign-ranks test, no significant change was observed between the mean platelet factor values at the beginning and at the end of one year. Conclusions : No significant changes of mean platelet activity were observed after continued administration of clozapine for 1 year. Considering the author's previous findings that observed a prominent decrease of mean platelet component after short-term clozapine administration, the result of this study suggests the possibility that the activity of the platelet may change depending on the duration of the clozapine administration.

Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease

  • Lee, Si Un;Kim, Tackeun;Kwon, O-Ki;Bang, Jae Seung;Ban, Seung Pil;Byoun, Hyoung Soo;Oh, Chang Wan
    • Journal of Korean Neurosurgical Society
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    • v.63 no.1
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    • pp.69-79
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    • 2020
  • Objective : To analyze trends in the incidence and treatment of diseases associated with ischemic stroke, namely, cerebral infarction (CI), cerebral arterial stenosis (CASTN), and moyamoya disease (MMD), based on Korean National Health Insurance Service (NHIS) data from 2008 to 2016. Methods : Data was extracted from the national health-claim database provided by the NHIS for 2008-2016 using International Classification of Diseases codes. The crude and age-standardized incidences of each disease (CI, CASTN without a history of CI, and MMD) were calculated; additional analyses were conducted according to age and sex. Trends in the number of patients undergoing treatment according to treatment method were analyzed for each disease using the Korean Classification of Diseases procedure codes. Results : In 2016, the total number of adults with newly diagnosed CI was 83939, reflecting a 9.4% decrease from that in 2008. The age-standardized incidence of CI in adults was 153.2 per 100000 person-years in 2016, reflecting a 37.2% decrease from that in 2008, while that of CASTN was 167.3 per 100000 person-years in 2016, reflecting a 73.3% increase from that in 2008. Among treated cases, the number of patients who underwent intra-arterial (IA) treatment, including IA fibrinolysis and mechanical thrombectomy, showed the most prominent increase, increasing at an annual rate of 25.8%. For CASTN, the number of cases treated with carotid artery stenting or balloon angioplasty (CAS) showed the most prominent increase, increasing at a rate of 69.8% over the 9-year period. For MMD, the total number of patients with newly diagnosed MMD and that with adult MMD demonstrated significantly increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over the 9-year period. The age-standardized incidences of pediatric and adult MMD in 2016 were 2.4 and 3.4 per 100000 person-years, respectively. Conclusion : Although the incidence of CI showed a declining trend over a 9-year period, the number and proportion of patients treated for CI increased. Meanwhile, the incidence of CASTN and the number of patients treated for CASTN have demonstrated increasing trends since 2008. On the other hand, the number of patients diagnosed with pediatric MMD decreased, despite no significant change in the incidence. In contrast, the number of patients and the incidence of adult MMD increased. These trends reflect changes in the population structure, gains in the accessibility of imaging examinations, and the development of endovascular techniques.

Time-synchronized measurement and cyclic analysis of ultrasound imaging from blood with blood pressure in the mock pulsatile blood circulation system (박동 혈액 순환 모의 시스템에서 시간 동기화된 혈압 및 혈액의 초음파 영상 측정 및 주기적 분석)

  • Min, Soohong;Jin, Changzhu;Paeng, Dong-Guk
    • The Journal of the Acoustical Society of Korea
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    • v.36 no.5
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    • pp.361-369
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    • 2017
  • Hemodynamic information in the carotid artery bifurcation is very important for understanding the development and progression mechanisms of cerebrovascular disease and for its early diagnosis and prediction of the progress. In this paper, we constructed a mock pulsatile blood circulation system using an anthropomorphic elastic vessel of the carotid artery bifurcation and ex vivo pig blood to acquire ultrasound images from blood and vessels synchronized with internal pressure while controlling the blood flow. Echogenicity, blood flow velocity, and blood vessel wall motion from the ultrasound images, and internal blood pressure were extracted over a cycle averaged from five cycles when the pulsatile pump rates are 20 r/min, 40 r/min, and 60 r/min. As a result, respectively, the peak systolic blood flow velocities were 20 cm/s, 25 cm/s, and 40 cm/s, the blood pressure differences were 30 mmHg, 70 mmHg, and 85 mmHg, the arterial walls were expanded to 0.05 mm, 0.15 mm, and 0.25 mm. Time-delayed cyclic variation of echogenicity compared to blood flow and pressure was observed, but the variation was minimal at 20 r/min. Time-synchronized cyclic variations of these parameters are important information for accurate input parameters and validation of the computational hemodynamic experiments which will provide useful information for the development and progress mechanisms of carotid artery stenosis.

DENTAL MANAGEMENT OF A PATIENT WITH MOYAMOYA DISEASE UNDER GENERAL ANESTHESIA (모야모야병(moyamoya disease) 환자의 전신마취 하 치과 치료)

  • Sang, Eun Jung;Song, Ji-Soo;Shin, Teo Jeon;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Lee, Sang-Hoon;Hyun, Hong-Keun
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.13 no.2
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    • pp.108-113
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    • 2017
  • Moyamoya disease is a disorder in which certain arteries in the brain are constricted. Blood flow can be blocked by the constriction and blood clots. The patients frequently experience transient ischemic attacks (TIA), cerebral hemorrhage, or may not experience any symptoms at all. It is reported that they have a higher risk of recurrent stroke and a distinct underlying pathophysiology. A 3-year-8-month old boy with moyamoya disease experienced cerebral infarctions five times, and he underwent a cerebrovascular anastomosis surgery four years ago. He showed swallow disturbance, general delayed development, hemiplegia, and strabismus. Also he had hypocalcified teeth with or without multiple caries lesions in all dentitions. Dental treatment under general anesthesia using sevoflurane was performed due to his lack of cooperation. Moyamoya disease is associated with various medical conditions requiring a thoughtful deliberation and a careful examination before and during dental treatment. Pain and anxiety control during dental treatment is important because hyperventilation induced by crying has been seen to trigger TIA. Both isoflurane and sevoflurane are commonly used in patients with MMD, but dynamic autoregulation is better preserved during sevoflurane than isoflurane anesthesia. So sevoflurance general anesthesia may be recommendable to manage dental patients having multiple caries with moyamoya disease.

Study on Relationship between constitution medicine and Prostaglandin E2 in Blood (사상인(四象人) 체질(體質)과 혈중(血中) Prostaglandin E2치(値)와의 관계(關係)에 관(關)한 연구(硏究))

  • Kim, Jong-Weon
    • Journal of Sasang Constitutional Medicine
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    • v.9 no.2
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    • pp.245-261
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    • 1997
  • The investigation were carried out the 37 patient with cerebrovascular accidents who had been treated in Oriental Medical Hospital in Kyung Hee University and in KangNam Uy Lim, and the 10 examinees who had been worked in Medical Hospital in Kyung Hee University. The consitution which had discriminated by survey, which had discriminated by study on the morphological diagrammings, which had discriminated by the result of the impatient of hospital on a dosage of constitutial prescription. The Prostaglandin E2 in blood for 47 persons (37 patients & 10 examinees) was measured. The following results were obtained. 1.In the constitution which had discriminated by survey, in the value of Prostaglandin E2 in bood of ammong four constitutiens didn,t showed significant differance. 2.In the constitution which had discriminated by study on the morphological diagrammings, in the value of Prostaglandin E2 in bood of ammong four constitutiens didn,t showed significant differance. 3.In the constitution which had discriminated by the result of patient of hospital on a dosage of constitutial prescription, the value of Prostaglandin E2 in blood of among four constitutions didn,nt showed signicant differance. 4.In the constitution which had discriminated by colligated three methods(survey, morphological diagrammings,the result of patient of hospital on a dosage of constitutial prescription), the value of Prostaglandin E2 in blood of ammong four constituion didn,t showed significant differnce. 5.In the constitution which had discriminated by survey, a test of significance between the value of Prostaglandin E2 in blood of each constitution and the value of Prostaglandin E2 in blood of the others was conducted. Only the value of Prostaglandin E2 in blood between in the TAE-EUM-IN(太陰人) and the others of female showed significant differance. 6.In the constitution which had discriminated by study on the morphological diagrammings,a test of significance between the value of Prostaglandin E2 in blood of each constitution and the value of Prostaglandin E2 in blood of the others was conducted. Only the value of Prostaglandin E2 in blood between in the SO-EUM-IN(少陰人) and the others of male showed significant differance. 7.In the constitution whichhad discriminated by the result of patient of hospital on a dosage of constitutial prescription,a test of significance between the value of Prostaglandin E2 in blood of each constitution and the value of Prostaglandin E2 in blood of the others was conducted. Only the value of Prostaglandin E2 in blood between in the TAE-EUM-IN(太陰人) and the others of male showed significant differance. 8.In the constitution which had discriminated was the colligated three methods(survey,morphological diagrammings,the result of patient of hospital on a dosage of constitutial prescription),a test of significance between the value of Prostaglandin E2 in blood of each constitution and the value of Prostaglandin E2 in blood of the others didn,t showed significant differnce. In this connected study is inadequete at present. But if the study is done persistently,the analysis of various ingredient in the body enables objectification in differentiation of four types of physical constitution as the supplemental method.

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The Hope of the Stroke Patients (뇌졸중환자의 희망)

  • 김이순
    • Journal of Korean Academy of Nursing
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    • v.27 no.1
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    • pp.212-227
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    • 1997
  • Cerebrovascular diseases in Korea is an important health problem since mortality and mobidity have been increased rapidly. It marked the 2nd cause of specific death rates in 1993. The stroke causes physical function disorder due to hemiparalysis and emotional disorder, and stroke patients experience helplessness, powerlessness. sense of alienation and loss of hope. These feelings make the rehabilitation difficult because they lose the will of life. The subjects of the study were seven citizens who live in Pusan, are over 50 years old and belong to low income-level. The data were collected from Jan. to Sep. 1995. The researcher as a caregiver and volunteer made confidence of them and asked for their agreement on the purpose of the study. The subjects expressed their experience as openheartedly as possible. The analysis of the data was made through the phenomenological analytic method suggested by Giorgi, which is as follows ; as an unit of description which include the subject' expressions and the researcher's observation, it is examined the theme that express the hope experience with the subject's language(underlining), and the focal meanings are identified. The focal meaning is the crystalization of the theme, which is written in the language of the researcher. After intergrating the focal meaning and make the situated structural description as the meaning of the hope experience identified on each subject's point. After intergrating the situated structural description and make the general structural description as the meaning of the hope experience identified on total subject's point then the systemizing of the structure of the hope experienced phenomena and the flowing of the conciousness was researched. The conclusions of this study was as follows : The ten sources of hope which the subjects experienced were sorted as under 〈mutual relations to others : spouse, children, relatives, fellow believer. health professioner. associate patient group〉, 〈spiritual dependence〉. 〈recovery of physical function〉. 〈rumination of the past life〉, 〈expectation of the future〉. 〈economic power〉, 〈belief〉, 〈ability〉. 〈spontaneous participation〉 and 〈recovery of roles〉. Their hope was spoken out by the following two kinds of linguistics. First. the hope was expressed in the affirmative expression as follows : 〈 to be dependable〉, 〈to make efforts〉, 〈to keep under control〉, 〈to desire〉, 〈to be pleasant〉, 〈to be peaceful〉, 〈to be grateful〉, 〈to give help〉, 〈self-confidence. Courage〉, 〈to be happy〉, 〈to satisfy oneself〉, 〈to share with others〉, 〈to understand〉 and 〈to be affected, be impressed〉 Second, the hope was expressed in the negative on pression as under : 〈to be distressed〉, 〈to be uneasy〉, 〈to be sorry, be unsatisfied〉 〈despair〉, 〈to abandon〉, 〈to be fearful〉, 〈to suffer〉, 〈to bear a burden〉 〈to be confused〉, 〈to be solitary〉, 〈chest trouble〉, 〈to feel heavy〉 〈grief〉, 〈to be daunted〉, 〈to get angry〉, 〈to be uncomfortable〉, 〈to have something regretable〉 and 〈to feel guilty〉. And their hope was expressed by the following four behavioral expressions : 〈physical sphere〉, 〈psychological sphere〉, 〈social support sphere〉 and 〈spiritual sphere〉. The reaction patterns of their hope experience appeared in the following 4 coping method : 〈conquest type〉, 〈dependence type〉, 〈adaptation type〉 and 〈fate type〉. Finally, in the hope structure the sense of certainty don't always coexict with the sense of uncertainty, When the stroke patients try to search for the best quality of life, the senses of certainty and uncertainty make a continual cyclic system in the hope structure.

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