Diverticular disease of the colon is frequently involved in Western countries, which in korea, it is regarding as rare disease. In Western the diverticulosis is mainly affected on left side and increasing in according to age and false type is more frequent than ture type. While in oriental countries, the diverticulosis of the colon is mainly affected on right side and it is more frequent in younger patients. Cecal diverticulitis is known to a very rare disease and very difficult to be differenciated from acute scopy has purnished another useful tool in the differential diagnosis of diverticular disease. We experienced a case of cecal diverticultitis which had been diagnosed by colonofiberscopy and reviewed literatures briefly.
Colon ; Diagnosis, Differential ; Diverticulitis* ; Diverticulum ; Humans ; Korea ; Rare Diseases

OBJECTIVES: School refusal can result from various causes; temperament, familial influences, and school experiences have been identified. This study was to compare family, school and psychological functioning in school-refusing adolescents and non-refusing ones. METHODS: Twenty-four school refusing outpatients aged 13-17 years were evaluated from May, 1998 to January, 1999. They completed self-report questionnaires, including Parent Bonding Instrument, Family Environment Scale, Index of Marital Satisfaction, Scales for School-related Distress, Center-for Epidemiological Studies-Depression, The Failure and Criticism Factor of Fear Survey Schedule from Children-revised. Their scores were compared with nonrefusers. RESULTS: The results were as follows: 1) School refusers perceived their family as more independence and achievement-oriented than nonrefusers. 2) School refusers did not differ significantly from nonrefusers in school-related distress. 3) School refusers had more depression than nonrefusers. 4) School refusers claimed more fear of having to go to school, and having to stay after school than nonrefusers. On the other hand, nonrefusers expressed greater apprehension about situations such as Being called on by the teacher, Getting poor grades, Failing a test, and Taking a test. CONCLUSION: The results suggested two postulated mechanisms of school refusals (overprotection and demanding of independence of parents) and possible causes of each result were discussed.
Adolescent* ; Appointments and Schedules ; Depression ; Disulfiram ; Hand ; Humans ; Outpatients ; Parents ; Surveys and Questionnaires ; Temperament ; Weights and Measures

BACKGROUND AND PURPOSE: Estimating age- and sex-specific population attributable risks (PARs) of major risk factors for stroke may be a useful strategy to identify risk factors for targeting preventive strategies. METHODS: For this case-control matched study, consecutive patients aged 18-90 years and admitted to nine nationwide hospitals with acute ischemic stroke between December 2008 and June 2010, were enrolled as cases. Controls, individually matched by age and sex, were chosen from the 4th Korean National Health & Nutrition Examination Survey (2008-2010). Based on odds ratios and prevalence, standardized according to the age and sex structure of the Korean population, PARs of major risk factors were estimated according to age (young, < or = 45; middle-aged, 46-65; and elderly, > or = 66 years) and sex subgroups. RESULTS: In 4,743 matched case-control sets, smoking (PAR, 45.1%) was the greatest contributing risk factor in young men, followed by hypertension (28.5%). In middle-aged men, the greatest contributing factors were smoking (37.4%), hypertension (22.7%), and diabetes (14.6%), whereas in women the greatest factors were hypertension (22.7%) and stroke history (10.6%). In the elderly, hypertension was the leading factor in men (23.7%) and women (23.4%). Other noticeable factors were stroke history (men, 19.7%; women, 17.3%) and diabetes (men, 12.5%; women, 15.1%). In young women, risk factors with a PAR greater than 10% were not found. CONCLUSIONS: Smoking cessation in young people and hypertension and diabetes control in older people may be effective in reducing the burden of stroke on the population. In the elderly, secondary prevention could also be emphasized.
Aged ; Case-Control Studies ; Female ; Humans ; Hypertension ; Male ; Odds Ratio ; Prevalence ; Risk Factors* ; Secondary Prevention ; Smoke ; Smoking ; Smoking Cessation ; Stroke*

BACKGROUND AND PURPOSE: Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. METHODS: We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. RESULTS: In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). CONCLUSIONS: Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.
Basilar Artery ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction* ; Cerebrovascular Disorders ; Constriction, Pathologic ; Hospital Distribution Systems ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Prevalence* ; Prognosis ; Republic of Korea ; Retrospective Studies ; Stroke ; Vertebral Artery

BACKGROUND AND PURPOSE: A substantial proportion of patients with atrial fibrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or after a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. METHODS: AIS patients with AF hospitalized within 7 days of onset were identified from a prospective nine-center stroke registry database. Two cohorts were defined: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score > or =2. RESULTS: Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. The rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. These rates varied widely for both cohorts, with interhospital differences being statistically significant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. CONCLUSIONS: This study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.
Atrial Fibrillation* ; Cerebral Infarction ; Cohort Studies ; Coronary Disease ; Drug Therapy ; Drug Utilization Review ; Guideline Adherence ; Heart Failure ; Humans ; Korea* ; Male ; Morinda ; Observational Study* ; Prospective Studies ; Stroke*

BACKGROUND AND PURPOSE: In order to improve inter-rater reliability and minimize diagnosis of undetermined etiology for stroke subtype classification, using a stroke registry, we developed and implemented a magnetic resonance imaging (MRI)-based algorithm for acute ischemic stroke subtype classification (MAGIC). METHODS: We enrolled patients who experienced an acute ischemic stroke, were hospitalized in the 14 participating centers within 7 days of onset, and had relevant lesions on MR-diffusion weighted imaging (DWI). MAGIC was designed to reflect recent advances in stroke imaging and thrombolytic therapy. The inter-rater reliability was compared with and without MAGIC to classify the Trial of Org 10172 in Acute Stroke Treatment (TOAST) of each stroke patient. MAGIC was then applied to all stroke patients hospitalized since July 2011, and information about stroke subtypes, other clinical characteristics, and stroke recurrence was collected via a web-based registry database. RESULTS: The overall intra-class correlation coefficient (ICC) value was 0.43 (95% CI, 0.31-0.57) for MAGIC and 0.28 (95% CI, 0.18-0.42) for TOAST. Large artery atherosclerosis (LAA) was the most common cause of acute ischemic stroke (38.3%), followed by cardioembolism (CE, 22.8%), undetermined cause (UD, 22.2%), and small-vessel occlusion (SVO, 14.6%). One-year stroke recurrence rates were the highest for two or more UDs (11.80%), followed by LAA (7.30%), CE (5.60%), and SVO (2.50%). CONCLUSIONS: Despite several limitations, this study shows that the MAGIC system is feasible and may be helpful to classify stroke subtype in the clinic.
Arteries ; Atherosclerosis ; Classification* ; Diagnosis ; Humans ; Magic ; Magnetic Resonance Imaging ; Recurrence ; Stroke* ; Thrombolytic Therapy

BACKGROUND AND PURPOSE: In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged > or =80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. METHODS: From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged > or = 80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. RESULTS: Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83+/-5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the in-hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). CONCLUSIONS: In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.
Aged* ; Asian Continental Ancestry Group ; Hospital Mortality ; Humans ; Intracranial Hemorrhages ; Korea ; Propensity Score ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator*

On page 47, the definition of stroke progression was erroneously described in the previous version of article.

Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2+/-12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.
Asian Continental Ancestry Group ; Humans ; Korea ; Length of Stay ; Male ; National Institutes of Health (U.S.) ; Stroke ; Tissue Plasminogen Activator