Subarachnoid hemorrhage (SAH) is a stroke subtype with high mortality and poor functional outcomes. Prompt occlusion of a ruptured aneurysm at an early stage is crucial to prevent rebleeding, which can result in even higher mortality and more severe disabilities. The most critical initial decision in SAH management is the choice of treatment method with surgical clipping or endovascular coiling. We aimed to develop an evidence-based clinical guideline to select the optimal initial treatment in patients with SAH. We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer two population, intervention, comparison, outcome questions comparing clipping and coiling. The risk of bias was assessed using ROB 2.0 and the Newcastle-Ottawa Scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcome and mortality. We included six randomized control trials (RCTs) and 58 observational studies. Meta-analysis of RCTs showed that coiling improved functional outcomes compared to clipping (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.86–0.97). No significant mortality difference was observed in RCTs (OR, 1.38; 95% CI, 0.91–2.09), but non-RCTs favored clipping for reduced mortality (OR, 0.77; 95% CI, 0.69–0.86). However, it is difficult to generalize these findings to all clinical situations, as patients with SAH have a highly variable clinical course. Final treatment decision should be tailored to the individual patient’s status, including aneurysm location, morphology, and the expertise available at the treatment center. Such decisions are best made by specialists such as a board-certified physician and should be explained to the patient and their caregivers, along with the rationale for selecting the most appropriate treatment at the given hospital. Korea has many certified endovascular neurosurgeons, cerebrovascular surgeons, and certified cerebrovascular centers. Proper selection of the most suitable treatment method by certified physicians and centers would greatly benefit patient outcomes and healthcare professionals.

The mothership (MS) model, where patients are directly transferred to a thrombectomy-capable center, and the drip-and-ship (DS) model, where thrombolysis is initiated at the nearest primary stroke center before transfer for thrombectomy, are the primary transport modes for patients with stroke. We aimed to establish guidelines for selecting the appropriate transfer strategy based on emergent large vessel occlusion (LVO). We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer three Population, Intervention, Comparison, and Outcome questions comparing MS and DS models. The risk of bias was assessed using the Newcastle-Ottawa Scale. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcomes, mortality, and successful recanalization. Twenty-six non-randomized controlled studies showed that the MS model improved good functional outcomes by approximately 14% compared with the DS model (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00–1.30). Fifteen studies reported that mortality in the MS and DS models showed no significant differences (OR, 0.97; 95% CI, 0.84–1.11). Twenty-four studies revealed no significant difference in successful recanalization between the MS and DS models (OR, 0.87; 95% CI, 0.68–1.10). The MS model should be considered first to improve the functional outcome of patients with LVO. However, if thrombectomy cannot be performed immediately after thrombolysis, or if a thrombectomy-enabled hospital is not nearby, the DS model should be considered by stroke specialists depending on transportation time and regional factors. We suggest a mixed approach with the DS model based on specific circumstances or regions to ensure the optimum treatment of patients with acute ischemic stroke (AIS). Appropriate transport for patients with LVO improves the prognosis of AIS.

PURPOSE: In order to develop the national guide-lines for the standardization of radiotherapy we are planning to establish a web-based, on-line data-base system for laryngeal cancer. As a first step this study was performed to accumulate the basic clinical information of laryngeal cancer and to determine the items needed for the data-base system. MATERIALS AND METHODS: We analyzed the clinical data of patients who were treated under the diagnosis of laryngeal cancer from January 1998 through December 1999 in the South-west area of Korea. Eligibility criteria of the patients are as follows: 18 years or older, currently diagnosed with primary epithelial carcinoma of larynx, and no history of previous treatments for another cancers and the other laryngeal diseases. The items were developed and filled out by radiation oncologist who are members of Korean Southwest Radiation Oncology Group. SPSS v10.0 software was used for statistical analysis. RESULTS: Data of forty-five patients were collected. Age distribution of patients ranged from 28 to 88 years (median, 61). Laryngeal cancer occurred predominantly in males (10:1 sex ratio). Twenty-eight patients (62%) had primary cancers in the glottis and 17 (38%) in the supraglottis. Most of them were diagnosed pathologically as squamous cell carcinoma (44/45, 98%). Twenty-four of 28 glottic cancer patients (86%) had AJCC (American Joint Committee on Cancer) stage I/II, but 50% (8/16) had in supraglottic cancer patients (p=0.02). Most patients (89%) had the symptom of hoarseness. Indirect laryngoscopy was done in all patients and direct laryngoscopy was performed in 43 (98%) patients. Twenty-one of 28 (75%) glottic cancer cases and 6 of 17 (35%) supraglottic cancer cases were treated with radiation alone, respectively. The combined treatment of surgery and radiation was used in 5 (18%) glottic and 8 (47%) supraglottic patients. Chemotherapy and radiation was used in 2 (7%) glottic and 3 (18%) supraglottic patients. There was no statistically significant difference in the use of combined modality treatments between glottic and supraglottic cancers (p=0.20). In all patients, 6 MV X-ray was used with conventional fractionation. The fraction size was 2 Gy in 80% of glottic cancer patients compared with 1.8 Gy in 59% of the patients with supraglottic cancers. The mean total dose delivered to primary lesions were 65.98 Gy and 70.15 Gy in glottic and supraglottic patients treated, respectively, with radiation alone. Based on the collected data, 12 modules with 90 items were developed for the study of the patterns of care in laryngeal cancer. CONCLUSION: The study items for laryngeal cancer were developed. In the near future, a web system will be established based on the items investigated, and then a nation-wide analysis on laryngeal cancer will be processed for the standardization and optimization of radiotherapy.
Age Distribution ; Carcinoma, Squamous Cell ; Diagnosis ; Drug Therapy ; Glottis ; Hoarseness ; Humans ; Joints ; Korea ; Laryngeal Diseases ; Laryngeal Neoplasms* ; Laryngoscopy ; Larynx ; Male ; Radiation Oncology ; Radiotherapy*

BACKGROUND AND OBJECTIVES: Brachytherapy is a promising method in the prevention and treatment of coronary stent restenosis. We sought to observe the therapeutic effects of a radioactive balloon loaded with Holmium-166 (166Ho) in a porcine coronary stent restenosis model. Materials and Methods: A radioisotope of (166Ho) was coated on the balloon surface using a polyurethane coating (20 Gy in 0.5 mm depth). Stent overdilation injuries were performed in two coronary arteries in 8 pigs. Four weeks after the stent overdilation injury, radiation therapies were performed using a control balloon dilation in one coronary artery (Group I:n = 8) and a 166Ho-coated balloon in the other coronary artery in each pig (Group II:n = 8). Follow-up coronary angiogram and histopathologic assessment were performed at 4 weeks after the therepy was administered. RESULTS: Laboratory findings did not differ significantly between the pre-treatment baseline and the measurements taken after radiation. On quantitative coronary angiogram, the coronary artery diameters were not significantly different between the two groups before stenting or at 4 and 8 weeks after stenting. On histopathologic analysis, injury score, internal elastic lamina area and lumen area did not differ significantly between the two groups. The neointimal area was 1.78 +/- 0.11 mm2 in group I and 1.36 +/- 0.12 mm2 in group II (p=0.017), and the histopathologic area of stenosis was 35.1 +/- 1.6% in Group I, 27.6 +/- 1.9% in Group II (p=0.005). CONCLUSION: A treatment of beta-radiation in a stented porcine coronary artery using radioactive Ho-166 coated balloon inhibits stent restenosis without any side effects.
Brachytherapy ; Constriction, Pathologic ; Coronary Disease ; Coronary Restenosis ; Coronary Vessels ; Follow-Up Studies ; Hyperplasia* ; Polyurethanes ; Radiation Injuries ; Radioisotopes ; Stents* ; Swine

BACKGROUND AND OBJECTIVES: Despite marked advances in the design of percutaneous coronary intervention hardware, total occlusion remains associated with a low primary success rate. The most common cause of failure is the inability to cross the lesion with a guidewire. We report the results of a non-randomized single-center investigation using a hydrophilic coated guidewire (Crosswire NT). SUBJECTS AND METHODS: We analyzed the angiographic results of 92 patients (68 males, 24 females, age 58.8+/-9.7 years-old) who underwent angioplasty utilizing Crosswire NT for either total (TIMI flow 1) or subtotal occlusion at Chonnam National University Hospital between December 2000 and July 2001. RESULTS: Clinical diagnoses of the studied subjects revealed 40 cases of acute myocardial infarction, 15 of myocardial infarction, 29 of unstable angina and 8 of stable angina. The primary success rate was 79.3% (73/92), the success rate in total occlusion was 69.0% (40/58), and that of the chronic total occlusion cases among the total occlusion group was 64.3% (18/28). The success rates in the use of Crosswire NT as the first and second choice were 85.7% and 78.8%, respectively. The abrupt occlusive lesions, complex lesions more than type B 2, and presence of collateral circulation were all associated with a lower success rate. Coronary artery perforation occurred in one case. CONCLUSION: The new nitinol hydrophilic wire, Crosswire NT, is a safe and effective tool for the recanalization of total occlusive coronary lesion.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Collateral Circulation ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention*

BACKGROUND AND OBJECTIVES: It has been reported that intracoronary radiation therapy (ICRT) using a Ho-166 coated balloon inhibits restenosis of porcine coronary arteries. However, the consequences of ICRT on coronary artery endothelial function are unknown. The aim of this study is to investigate the effects of ICRT using a Ho-166 balloon on coronary artery endothelial function and vasomotor reactivity. MATERIALS AND METHODS: Female pigs (25-35 kg) were orally premedicated daily with aspirin (100 mg) and ticlopidine (250 mg) for the duration of the study. Under sterile conditions with local anesthesia of the skin provided by 2% lidocaine, an arteriotomy of the left carotid artery was performed, an 8 Fr sheath was inserted, and intraarterial heparin sodium (10,000 IU) was injected. Under fluoroscopic guidance, the coronary artery main branch was selected through an 8 Fr guiding catheter for coronary artery overdilation injury (balloon to artery ratio, 1.3:1) and ICRT. A Ho-166 coated balloon prepared to deliver 20 Gy at a depth of 2 mm from the balloon surface was used for ICRT. The coronary artery main branch in each pig was randomly assigned to either balloon injury (Group I) or balloon injury plus ICRT (Group II). Coronary artery segments were taken from the animals at 0 week (n=8), 4 weeks (n=6) and 8 weeks (n=8) after the intervention. Data in each group denote the relative ratio compared to non-injured coronary artery and are expressed as mean +/- standard error of mean. RESULTS: The degree of KCl-induced contractile response (g) was not different between the two groups at 0 and 4 weeks, but was significantly decreased in group II compared to group I at 8 weeks (I:1.04+/-0.06, II:0.79+/-0.07, p=0.014). In rings precontracted with prostaglandin F 2alpha (PGF 2alpha), the degree of NO-dependent relaxation (%) induced with substance P was significantly decreased in group II compared to group I at 0 week (I:0.93+/-0.33, II:0.47+/-0.31, p=0.03), but the difference between the two groups was not significant at 4 and 8 weeks. In rings precontracted with PGF 2alpha and LAME in the presence of indomethacin, the degree of EDHF-induced relaxation (%) using substance P was not different between the two groups at 0, 4 and 8 weeks; nor was the degree of sodium nitroprusside-induced endothelium independent relaxation (%) in depolarized conditions with PGF 2alpha. CONCLUSION: Endothelial function of the porcine coronary artery is only transiently impaired after ICRT using a Ho-166 coated balloon. Therefore this therapy can be used as an effective method to prevent restenosis after percutaneous coronary intervention.
Anesthesia, Local ; Angioplasty ; Animals ; Arteries ; Aspirin ; Carotid Arteries ; Catheters ; Coronary Restenosis ; Coronary Vessels ; Endothelium ; Female ; Heparin ; Humans ; Indomethacin ; Lidocaine ; Percutaneous Coronary Intervention ; Prostaglandins F ; Relaxation ; Skin ; Sodium ; Substance P ; Swine ; Ticlopidine

BACKGROUND: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. METHODS: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9+/-9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43+/-0.14 mg/dL) on admission and Group II (n=122, 59.1+/-10.4 years, male 83.6%) with elevated CRP (> or = 1.0 mg/dL, mean value=3.50+/-0.93 mg/dL) on admission. RESULTS: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4+/-10.5 to 52.0+/-9.0%, 1.52+/-1.13 to 2.77+/-0.55, p<0.001 vs Group II; 50.1+/-11.2 to 52.7+/-9.7, 1.55+/-1.11 to 2.76+/-0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). CONCLUSION: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.
C-Reactive Protein* ; Humans ; Incidence ; Inflammation ; Jeollanam-do ; Male ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prognosis ; Shock, Cardiogenic ; Survival Rate

BACKGROUND AND OBJECTIVES: There has been few study on the epidemiology and clinical characteristics of ventricular tachycardia (VT) in Korea, although their determination is crucial to the management of VT. The purpose of this study is to determine the clinical characteristics of VT. MATERIALS AND METHODS: Hospital medical records were reviewed on clinical characteristics including demographic feature, underlying disease, and clinical presentation in 66 patients who visited emergency room or out-patient clinic with VT as a primary medical problem from April 1996 to March 1999. The diagnosis of VT was made based on physical signs and ECG recording during the VT and confirmed with electrophysiology study in some cases. RESULTS: There were 42 men and 24 women (mean age: 50.218.9 years). The most common presenting symptom was palpitation (n=30), which was followed by dyspnea (n=18), syncope (n=11), sudden death (n=5). Five patients had no specific symptom. Underlying disease was coronary artery disease in 18 (27.3%) patients, dilated or hypertrophic cardiomyopathy in 11 (16.7%), valvular heart disease in 7 (10.6%), myocarditis in 3 (4.5%), but absent in 20 (30.3%). Idiopathic VT (n=16) usually originated from either right ventricular outflow tract (RVOT, 56.3%) or left ventricular septum (LVS, 31.3%). One-year cardiac mortality rate was 43.8% in coronary artery disease (n=16), 20.0% in cardiomyopathy (n=10), 33.3% in valvular heart disease (n=6), but zero in idiopathic VT (n=19). CONCLUSIONS: These findings suggest that idiopathic VT may be the most common type of VT in Korea and usually originates from either RVOT or LVS. The response to medical therapy is poor in VT with underlying heart disease but excellent in idiopathic VT.
Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Coronary Artery Disease ; Death, Sudden ; Diagnosis ; Dyspnea ; Electrocardiography ; Electrophysiology ; Emergency Service, Hospital ; Epidemiology ; Female ; Heart Diseases ; Heart Valve Diseases ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Myocarditis ; Outpatients ; Syncope ; Tachycardia, Ventricular* ; Ventricular Septum

The elevation and fusion of palatine are essential processes in the completion of the palatal development. It is believed that the mesenchyme plays a major role in the ascent of the palatal process, and that the palatal epithelium is involved in its fusion. The mechanism of fusion requires several different morphologic and molecular changes prior to the completion of the mesenchymal continuity between different palatine processes. The mechanism of removing the epithelial cells from the fusion zone could include either programmed cell death, epithelial-mesenchymal transformation or migration to adjacent epithelia. Retinoic acid has been known to induce cleft palate by disturbing mesenchymal growth and/or epithelial fusion. The effect of retinoic acid on the epithelium of the palatine process was studied in the fetus of the Sprague- Dawley rat with feeding 100 mg/kg of retinoic acid mixed in olive oil on the 10th day of fetal age and controlled with feeding pure olive oil. The epithelium of the palatine process was examined by PAS reaction and electron- microscopy on the 14th, 15th, 16th and 18th day of fetal age. The obtained results were as follows: 1. In the control group, glycogen was plentiful at the entire epithelium of the palatine process during the pre-fusion period(14th and 15th day), but it diminished in contact epithelium at the fusion stage(16th day). On the contrary, in the experimental group treated with retinoic acid, glycogen was plentiful and did not change from the 14th to 18th day of gestation. 2. In the control group at fusion stage(16th and 18th day), PAS-positive cells increased in the nasal and oral epithelium adjacent to the fusion site, and in the mesenchyme around the fusion site. 3. As a result of electronmicroscopic findings, the epithelium in the experimental group with retinoic acid seemed to be injured by retinoic acid; RER was composed of flattened cisternas and ribosomes were detached, mitochondrial crista and membrane were destructed and sacculated, and Golgi complex was extremely atrophied. According to the results, it seems that apoptosis as well as cell migration and transformation happen in the mechanism of cleaning the epithelium at the contact site, and that retinoic acid injures directly intracytoplasmic organelles and disturbs apoptosis, a sort of normal developmental process. More studies should be done to verify relations between apoptosis and large-sized glycogen granule in superficial epithelium.
Animals ; Apoptosis ; Cell Death ; Cell Movement ; Cleft Palate ; Epithelial Cells ; Epithelial-Mesenchymal Transition ; Epithelium* ; Fetus* ; Gestational Age ; Glycogen ; Golgi Apparatus ; Membranes ; Mesoderm ; Microscopy ; Olea ; Organelles ; Periodic Acid-Schiff Reaction ; Pregnancy ; Rats* ; Ribosomes ; Tretinoin* ; Olive Oil

This study aimed to assess the potential usefulness of optical coherence tomography[OCT]for the diagnosis of central serous chorioretinopathy. OCT was used to examine 50 patients[50 eyes]whose initial examination disclosed the clinical diagnosis of central serous chorioretinopathy. Optical coherence tomographic section acquired directly through the fovea showed an increase of the neurosensory retina above an optically clear space corresponding to a fluid-filled cavity. Serial OCT were able to demonstrate a decrease in the sensory retina elevation from[900~120]micrometer t o [130~0]micrometer for 3 months of period. This resolution correlated with an improvement in the patient's visual acuity. OCT is potentially useful as a new, noninvasive diagnostic technique for quantitative examination by objectively monitoring the degree of serous retinal detachment in patients with central serous chorioretinopathy.
Central Serous Chorioretinopathy ; Diagnosis* ; Humans ; Retina ; Retinal Detachment ; Tomography, Optical Coherence ; Visual Acuity