• 제목/요약/키워드: clinical incidence and prognosis

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중대뇌동맥 동맥류 파열 환자의 출혈 양상에 대한 임상적 분석 (The Clinical Analysis of Bleeding Pattern in Patients with Ruptured Middle Cerebral Artery Aneurysm)

  • 김훈;심영보;황형식;최재준;김성민;박용기;최선길
    • Journal of Korean Neurosurgical Society
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    • 제30권6호
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    • pp.699-704
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    • 2001
  • Objectives : The rupture of middle cerebral artery(MCA) aneurysm usually cause or is associated with higher incidence of intracerebral hemorrhages(ICH) than any other aneurysmal ruptures. Also, the outcome of patients who had ICH is known to be worse than patients who had subarachnoid hemorrhage(SAH) only. The authors report the bleeding pattern and outcome of ruptured MCA aneurysm patients. Patients and Methods : A total 106 ruptured MCA aneurysm patients who were surgically treated were included and they were divided into 2 groups by the initial brain CT findings according to the presence or absence of ICH over 10cc in amount. The clinical data were analysed retrospectively. Results : The overall mortality was 18.9%. Among 81 patients(76.4%) who had subarachnoid hemorrhage(SAH) only, 68 patients(84%) showed favorable outcome. Twenty five patients(23.6%) had ICH over 10cc in amount with or without SAH, and among them, 11 patients(44%) showed favorable outcome. The ICH was located in temporal lobe(15 patients, 60%), frontal lobe(3, 12%), sylvian fissure(6, 24%) and frontal-temporal lobe(1, 4%). Among 15 patients who had ICH in temporal lobe, only 4 patients(26.6%) showed favorable outcome and all 3 patients who had ICH in frontal lobe showed favorable outcome. Conclusion : ICH was presented in 23.6% of ruptured MCA aneurysm patients and the prognosis of patients with ICH was worse than patients with SAH only. The ICH was located mainly in the temporal lobe and sylvian fissure.

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뇌졸중환자에 대한 연례보고(V) (Yearly Report on Cerebrovascular Accident Patients(V))

  • 고승희;전찬용;박종형
    • 대한한의학회지
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    • 제21권3호
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    • pp.129-139
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    • 2000
  • Clinical observation was made on 210 cases of CVA that were confirmed through brain CT, MRI scan and clinical observation. They were hospitalized in the oriental medical hospital of Kyungwon University from January to December in 1998. Objective : To evaluate the current status of cerebrovascular disease in Korea, we performed observation on stroke patients. Methods : We performed a retrospective study on 210 cases of stroke who had been admitted to the Dept. of Internal Medicine, College of Oriental Medicine, Kyungwon University from Jan. 1, 1998 to Dec. 31, 1998. Results : The incidence was highest in the patients with the age of above fifty. The frequency of strokes was similar between male and female cases. Ischemic stroke(70.0%) was more common than hemorrhagic stroke(20.5%), with transient ischemic attacks(9.5%) occuring less frequently. Middle cerebra! arterial territory was the most commonly involved site in ischemic strokes. Among intracerebral hemorrhages, putaminal hemorrhages were found in 69.8%, and was followed by IVH(9.3%), IVH with ICH(7.0%), subcortical hemorrhages (4.7%) and pontine hemorrhages(4.7%). The most ordinary preceding disease was hypertension. The next was diabetes mellitus. Most cases were given simultaneous treatment in both western and oriental medical methods. Conclusions : Generally it is thought that CVA occurs frequently in winter. But our observations reveal no such relationship. The predisposing factors of cerebral infarction were usually initiated during the time of resting and sleeping and those of cerebral hemorrhage chiefly during the time of exercising. I Patients whose condition of consciousness was bad at the time of admission tended to have a bad prognosis. This study suggests changing trends of stroke in Korea, and that a multicenter prospective study using stroke registry is required for confirmation.

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Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

  • Choi, Hyun-Jung;Kim, Min Chul;Sim, Doo Sun;Hong, Young Joon;Kim, Ju Han;Jeong, Myung Ho;Kim, Soo-Hyun;Shin, Myung-Geun;Ahn, Youngkeun
    • Annals of Laboratory Medicine
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    • 제38권6호
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    • pp.538-544
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    • 2018
  • Background: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. Methods: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. Results: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P =0.005). Conclusions: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

경흉부 심초음파에서 관찰된 엡스타인 기형: 증례보고 2례 (Ebstein's Anomaly in Transthoracic Echocardiography: Two Case Reports)

  • 김성희
    • 대한임상검사과학회지
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    • 제51권2호
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    • pp.265-269
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    • 2019
  • 엡스타인 기형은 삼첨판엽이 삼첨판륜에 붙지 않고 아래쪽 우심실 첨부 쪽으로 내려가 우심실 안에 붙는 심장 기형으로 대부분에서 20대까지 생존하는 것으로 되어 있으며 25세 이상에서는 심부전과 급사의 발생이 비슷하였으며 약 70%에서 2세까지 생존하고, 50%에서 3세까지, 5%이하에서 50세 이상까지 생존한다. 본 예를 통해 엡스타인 기형은 다양한 형태로 존재함을 경험하였고, 22세의 WPW 증후군이 동반된 예와 77세까지도 생존하고 있는 예를 보고하는 바이다. 아울러 심첨 4강 단면도에서 정상적인 심장구조는 승모판륜보다 삼첨판륜이 심첨 쪽으로 약간 내려가 있기는 하나 거의 비슷한 선에서 관찰되어야 하는데 그렇지 않다면 반드시 이 기형을 의심해 봐야 한다. 더 나아가 선천성 심장기형의 진단 및 예후를 파악하는데 심장초음파는 중요한 역할을 하고 있으며 필수검사로 임상에서 활용되어지고 있다.

최근 10년간(1988~1998) 경기지역 소아에서 A형 간염의 역학적 변화 및 임상에 관한 연구 (Epidemiological Changes and Clinical Features of Hepatitis A in Children, Living in Kyung-gi Province, Since 1988 to 1998)

  • 김현;김종현;김동언;허재균;이원배;서병규;강진한
    • Pediatric Infection and Vaccine
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    • 제5권2호
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    • pp.230-238
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    • 1998
  • 목 적 : 오염된 식수나 음식물에 의하여 전파되는 A형 간염은 전세계적으로 과거에 비해 현저한 발생 감소를 보이고 있고 국내에서도 1980년대 중반 이후부터는 돌발적 유행 양상은 소실되었고 매우 적은 수의 산발적 발생안 보고 되고 있다. 그러나 최근에 와서 성인과 소아에서 A형 간염이 점차 증가하는 추세를 보이고 있어 저자들은 최근 10년간 경기지역의 15세 이하의 소아에서 A형 간염의 역학적 변화와 이들 환아의 임상적 특성에 관하여 연구를 실시하였다. 대상 및 방법 : 1988년 7월부터 1998년 8월까지 경기지역에 있는 가톨릭대학교 의과대학 성모자애병원, 성가병원, 의정부성모병원, 성인센트병원에 임원된 환아중 혈청학적으로 A형 간염으로 진단된 환아들의 의무기록을 통하여 후향적으로 A형 간염의 연별, 월별, 연령별, 성별 발생상태와 발생과 연관된 역학적 특성, 그리고 임상적 특성, 경과 및 합병증 등에 관하여 분석하였다. 결 과 : 1) 연구 기간동안 46명이 A형 간염으로 진단되었고, 이들 환아중 28명(60.1%)이 1998년에 집중적으로 발생되었다. 2) 이들 환아는 연중 3월에서 7월 사이에 주로 발생되었고 또한 10세 이상의 연령(37명, 80.4%)에서 발생되었으며 남녀비는 1.2:1.0이었다. 3) 연구 환아들 부모의 사회경제 및 교육 정도는 중등도 이하가 각각 97.8%. 87.0%으로 낮았다. 그리고 이들 환아는 원인이 뚜렷하지 않고 집단적 발생은 없었으나 2례에서 가족내 발생이 확인되었다. 4) 임상적으로 내원시 이들 환아의 주소는 구토 및 구역, 황달, 식욕부진, 경미한 발열, 권태감, 복통, 상기도증상, 소화장애, 짙은 소변, 두통, 설사의 순으로 호소하였고, 진찰소견상에서는 황달, 간비대, 우상복부 압통, 비장종괸, 좌하복부 압통의 순으로 이상 소견을 보였다. 5) 간기능 검사상 전례에서 비정상적인 소견과 담즙 정체성 간염의 소견이 관찰되었으나 이들 소견은 2~4주 사이에 정상화되었다. 또한 복부 초음파 및 간동위원소 검사상 당낭벽 비후, 간비대, 비장비대, 복수 등의 소견이 관찰되었다. 6) 이들 연구 환아들의 평균 임원일 수는 11.1일이었고 전례에서 합병증 없이 좋은 경과를 보였다. 결 론 : 최근 10년간 경기지역에서 A형 간염의 발생의 양상은 사회경제 및 교육 정도가 낮은 가정의 10세 이상의 연령 소아에서 1998년도에 집중적으로 발생되고 있음을 알 수 있었고, 전례에서 비정상적인 간기능 소견이 관찰되었고 다수에서 담즙 정체성 간염의 양상을 보였으나 합병증 없이 좋은 임상 경과가 있었음을 확인하였다.

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Exploring the DNA methylome of Korean patients with colorectal cancer consolidates the clinical implications of cancer-associated methylation markers

  • Sejoon Lee;Kil-yong Lee;Ji-Hwan Park;Duck-Woo Kim;Heung-Kwon Oh;Seong-Taek Oh;Jongbum Jeon;Dongyoon Lee;Soobok Joe;Hoang Bao Khanh Chu;Jisun Kang;Jin-Young Lee;Sheehyun Cho;Hyeran Shim;Si-Cho Kim;Hong Seok Lee;Young-Joon Kim;Jin Ok Yang;Jaeim Lee;Sung-Bum Kang
    • BMB Reports
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    • 제57권3호
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    • pp.161-166
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    • 2024
  • Aberrant DNA methylation plays a critical role in the development and progression of colorectal cancer (CRC), which has high incidence and mortality rates in Korea. Various CRC-associated methylation markers for cancer diagnosis and prognosis have been developed; however, they have not been validated for Korean patients owing to the lack of comprehensive clinical and methylome data. Here, we obtained reliable methylation profiles for 228 tumor, 103 adjacent normal, and two unmatched normal colon tissues from Korean patients with CRC using an Illumina Infinium EPIC array; the data were corrected for biological and experiment biases. A comparative methylome analysis confirmed the previous findings that hypermethylated positions in the tumor were highly enriched in CpG island and promoter, 5' untranslated, and first exon regions. However, hypomethylated positions were enriched in the open-sea regions considerably distant from CpG islands. After applying a CpG island methylator phenotype (CIMP) to the methylome data of tumor samples to stratify the CRC patients, we consolidated the previously established clinicopathological findings that the tumors with high CIMP signatures were significantly enriched in the right colon. The results showed a higher prevalence of microsatellite instability status and MLH1 methylation in tumors with high CMP signatures than in those with low or non-CIMP signatures. Therefore, our methylome analysis and dataset provide insights into applying CRC-associated methylation markers for Korean patients regarding cancer diagnosis and prognosis.

심장 관상동맥 외과 (The Clinical Summary of the Coronary Bypass Surgery)

  • 정황규
    • Journal of Chest Surgery
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    • 제13권3호
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    • pp.174-185
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    • 1980
  • It was my great nohour that I can be exposed to such plenty materials of the coronary bypass surgery. Here, I am summarizing the xoronary bypass surgery, clinically. The material is serial 101 patients who underwent coronary bypass surgery between July 17, 1979 to November 30, 1979 in Shadyside Hospital, University of Pittsburgh. 1. Incidence of the Atherosclerosis is frequent in white, male, fiftieth who are living in industrialized country. It has been told the etiologic factor of the atherosclerosis is hereditary, hyperlipidemia, hypertension, smoking, drinking, diabetes, obesity, stress, etc. 2. The main and most frequent complication of the coronary atherosclerosis is angina pectoris. Angina pectoris is the chief cause of coronary bypass surgery and the other causes of coronary bypass surgery are obstruction of the left main coronary artery, unstable angina, papillary muscle disruption or malfunction and ventricular aneurysm complicated by coronary artery disease. 3. The preoperative clinical laboratory examination shows abnormal elevation of plasma lipid in 82 patint, plasma glucose in 40 patient, total CPK-MB in 24 patient stotal LDH in 22 patient out of 101 patient. 4. Abnormal ECG findings in preoperative examine were 29.1% myocardial infarction, 25.8% ischemia and injury, 14.6T conduction defect. 5. Also we had done Echocardiography, Tread Mill Test, Myocardial Scanning, Vectorcardiography and Lung function test to get adjunctive benefit in prediction of prognosis and accurate diagnosis. 6. The frequency of coronary atherosclerosis in main coronary arteries were LAD, RCA and Circumflex in that order. 7. The patients' main complaints which were became as etiologic factor undergoing coronary bypass surgery were angina, dyspnea, diaphoresis, dizziness, nausea and etc. 8. For the coronary bypass surgery, we used cardiopulmonary bypass machine, non-blood, diluting prime, cold cardioplegic solution and moderate cooling for the myocardial protection. 9. We got the grafted veins from Saphenous and Cephalic vein. Reversed and anastomosed between aorta and distal coronary A. using 5-0 and 7-0 prolene continuous suture. Occasionally we used internal mammary A. as an arterial blood source and anastomosed to the distal coronary A. and to side fashion. 10. The average cardiopulmonary bypass time for every graft was 43.9 min. and aortic clamp time was 23 minute. We could Rt. coronary A. bypass surgery only by stand by the cardiopulmonary machine and in the state of pumping heart. 11. Rates by the noumbers of graft were as follow : 21.8% single, 33.7% double, 26.7% triple, 13.9% quadruple, 3% quintuple and 1% was sixtuple graft. 12. combined procedures with coronary bypass surgery were 6% aneurysmectomy, 3% AVR, 1% MVR, 13% pacer implantation and 1% intraaortic ballon setting. 13. We could see the complete abolition of anginal pain after operation in 68% of patient, improvement 25.8%, no change in 3.1%, and there was unknown in 3%. 14. There were 4% immediate postoperative deaths, 13.5% some kinds of heart complication, 51.3% lung complications 33.3% pleural complications as prognosis.

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Value of KRAS, BRAF, and PIK3CA Mutations and Survival Benefit from Systemic Chemotherapy in Colorectal Peritoneal Carcinomatosis

  • Sasaki, Yusuke;Hamaguchi, Tetsuya;Yamada, Yasuhide;Takahashi, Naoki;Shoji, Hirokazu;Honma, Yoshitaka;Iwasa, Satoru;Okita, Natsuko;Takashima, Atsuo;Kato, Ken;Nagai, Yushi;Taniguchi, Hirokazu;Boku, Narikazu;Ushijima, Toshikazu;Shimada, Yasuhiro
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권2호
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    • pp.539-543
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    • 2016
  • Background: It is well known that peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is associated with a poor prognosis. However, data on the prognostic significance of modern chemotherapy containing bevacizumab, cetuximab or panitumumab are not available. Materials and Methods: This retrospective review concerned 526 patients with metastatic CRC who were classified into two groups according to the presence or absence of PC, and were treated with systemic chemotherapy, with or without bevacizumab or anti-EGFR antibodies. The genetic background, in particular KRAS, BRAF, and PIK3CA gene mutations, and overall survival (OS) were compared between the two groups. Results: The median OS values were 23.3 and 29.1 months for PC and non-PC patients, respectively (hazard ratio [HR]=1.20; p=0.17). Among all patients, tumor location, number of metastatic sites and BRAF mutation status were significant prognostic factors, whereas the presence of PC was not. In the PC group, chemotherapy with bevacizumab resulted in a significantly longer OS than forchemotherapy without bevacizumab (HR=0.38, p<0.01), but this was not the case in the non-PC group (HR=0.80, p=0.10). Furthermore, the incidence of the BRAF V600E mutation was significantly higher in PC than in non-PC patients (27.7% versus 7.3%, p<0.01). BRAF mutations displayed a strong correlation with shorter OS in non-PC (HR=2.26), but not PC patients (HR=1.04). Conclusions: Systemic chemotherapy, especially when combined with bevacizumab, improved survival in patients with PC from CRC as well as non-PC patients. While BRAF mutation demonstrated a high frequency in PC patients, but it was not associated with prognosis.

口眼와斜에 대한 臨床的 考察 (A clinical study on facial paralysis.)

  • 안수기;황충연
    • 한방안이비인후피부과학회지
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    • 제4권1호
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    • pp.89-98
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    • 1991
  • Clinical study on the 114 facial paralysis patients, visited Won Kwang University Oriental Medical Hospital in Kwang ju from July 1990 to Jun 1991, was carried out. The results obtained are as follows. 1. Prevalence was almost same in both sexes and high in the age of 3 and 4 decades but distributed in an age group. 2. Majority of the patients were nomotensive, which meant blood pressure did not affect the incidence. 3. The incidence distributed in every occupations but high in housewife as 37 cases ($32\%$) and decreased gradually in office employee, labor worker, student and merchant in order. 4. Overwork, wind and cold, emotional stress, and numerous implicated agents were etiological factor. 5. The paralysis mostly occured in summer and winter as 40($35\%$) and 37 cases($32\%$) respectively, 18($16\%$) and 19cases($17\%$) were recorded respectively in spring and autumn. 6. The majority of patients showed only facial muscle paralysis without other complications, whose cure rate was $60\%$ (47 cases). The patients with auditory impairment or taste loss was less common and cure rate was low. 7. The number of the patients with migraine or mastoid pain was 81($71\%$), which was more than 33 patients($29\%$) with such pain. The cure rate was high in the patients without migraine than with migraine as a raito of 64 to $46\%$. 8. Most of duration from attack to admission were in a week as 86 cases($75\%$) and the patients with duration over 4 weeks 11 cases($10\%$). The cure rate of the patients in a week, was 54 cases($60\%$) and the patients over 4 weeks was none($0\%$), which meant shorter the duration was, the beter the result was. 9. Response on electro acupuncture on initiating therapy showed good in 39 cases($34\%$) the majority group, moderate in 37 cases, exellent in 29 cases and poor in 5 cases. 10. The results of treatment were as follows : asymptomatic in 58 cases($51\%$), improved n 40cases($35\%$), effective in 10 cases($9\%$) and ineffective in 6 cases($5\%$). 11. Cure rate according to the response on electro acupuncture showed $72\%$ in exellent group, $59\%$ in good group, $27\%$ in moderate groop, and $0\%$ in poor group. These show the better the response on the electro-acupuncture is, the higher the cure rate is, which will be able to indicate the prognosis of facial paralysis.

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아데노신 부하 1시간 지연 Tc-99m tetrofosmin 게이트 심근 SPECT에서 관찰되는 심장 대 폐 섭취비의 임상적 유용성: 관상동맥조영술과의 비교 (The Clinical Efficacy of Lung to Heart Ratio in 1 Hour Delayed Tc-99m Tetrofosmin Gated Myocardial SPECT after Adenosine Stress: Comparison with Coronary Angiography)

  • 원경숙
    • Nuclear Medicine and Molecular Imaging
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    • 제42권5호
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    • pp.362-368
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    • 2008
  • 목적: T1-201 심근 SPECT에서 심장 대 폐 섭취비의 증가(LHR)는 심근관류스캔의 고위험소견으로 알려져 있으나, 약물부하 Tc-99m tetrofosmin 게이트 심근 SPECT에서 측정되는 LHR도 같은 역할을 하는지에 대하여는 의문이 있다. 이에 저자는 약물부하 Tc-99m tetrofosmin 게이트 심근 SPECT에서 측정된 LHR과 관상동맥조영술 및 게이트 심근관류 SPECT소견을 비교하여 이의 유용성을 알아보고자 하였다. 대상 및 방법: 관상동맥질환이 의심되어 아데노신 부하 Tc-99m tetrofosmin 게이트 심근 SPECT를 시행한 환자 중 관상동맥조영술을 한 달 이내에 시행한 환자 157명을 대상으로 하였다. 게이트 SPECT는 먼저 휴식기 영상을 얻고, 3-4시간 후 아데노신 부하 영상을 얻었다. 총 157명의 대상환자에서 측정된 LHR과 관상동맥조영슬과 게이트 심근 관류 SPECT 결과를 비교하였다. 결과: 정상 대조군 50명에서 얻은 LHR은 $0.33{\pm}0.04$이었으며, 성별의 차이는 없었다. LHR이 0.41(평균+2표준편차)을 초과한 경우 LHR이 증가된 것으로 간주하였다. 정상관상동맥을 보인 53명 중 2명 (3.8%), 단일혈관질환 44명에서는 0명, 두혈관질환 27명 중 2명(7.4%), 세혈관질환 33명 중 8명(24.2%)에서 증가된 LHR을 보였다. LHR은 부하기 및 휴식기의 좌심실구혈률과 약한 음의 상관관계를 보였으며(r=-0.25, -0.25), 부하기 및 휴식기 관류결손의 총합과는 약한 양의 상관관계를 보였다(r=0.37, 0.36). 결론: 약물부하 후 1시간에 촬영한 Tc-99m tetrofosmin의 LHR은 세혈관질환을 가진 군과 심한 좌심실 기능부전을 가진 군, 그리고 부하기 및 휴식기 영상에서 심한 관류결손을 가진 군에서 높아서, 기존의 T1-201을 이용한 연구와 비슷하였으나, 연관성은 낮았다.