Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.

Background: Because Korea is the fastest aging country, the stroke incidence is increasing rapidly. We investigate the trend of the number of patients with acute stroke in recent years and estimate the burden of the neurologist to treat the acute stroke patient visited the emergency department. Methods: We requested a questionnaire survey to all teaching hospitals on the number of hospital beds, the number of stroke patients who visited the emergency department, the number of stroke patients in charge of the neurologist, and the number of days on duty of residents from 2016 to 2019. Results: Of 69 teaching hospitals, 41 hospitals answered the survey. The average hospital beds per hospital were increased annually from 909 to 916. The average patients who visited the emergency department with stroke and were in charged to neurologists were rapidly increased from 799 to 867 per hospital. In particular, the number of patients with hyperacute cerebral infarction requiring the thrombolytic administration or mechanical thrombectomy were rapidly increased from 105 to 131. On the other hand, the average number of residents per hospital was decreased from 5.1 to 4.8. Therefore, the days on duty per resident were increased from 74 to 77. Conclusions The number of acute stroke patients, especially, hyperacute stroke required the rapid cooperation and high labor were increasing rapidly in recent years. However, because the number of residents were decreased, the burden was increasing. To improve the quality of acute stroke treatment, it is necessary to increase the number of residents.

BACKGROUND: Strong immunosuppressive regimens have steadily improved both graft and patient survival, but posttransplant malignancy is still a clinical issue that needs to be resolved. METHODS: There were 1,500 transplant recipients between 1969 and 2005 at Kangnam St. Mary's hospital. The mean follow-up period was 108 77 months. We retrospectively analyzed the incidence, clinical course, treatment and prognosis of malignancy in the kidney transplant recipients. RESULTS: The incidence of malignancy after transplantation was 7.0% (10.5 cases out of 103 patients). The incidence of malignant lymphoma, thyroid cancer, renal cell carcinoma and Kaposi's sarcoma were higher in the renal transplanted patients than in the general population. The cancer incidence for women was higher than that for men, with stomach cancer being the most common in males and uterine cervix cancer the most common in females. The cumulative incidence of posttransplant malignancy at 1990, 1995, 2000 and 2005 were 0.72%, 2.91%, 4.62% and 7.0%, respectively. The cancer incidence with the use of initial immunosuppressive agents was 8.3% for azathioprine, 7.6% for cyclosporine, and 3.4% for tacrolimus. The mean times for making the diagnosis of malignancy after transplantation were 172+/-61 months for azathioprine, 91+/-49 months for cyclosporine, and 57+/-28 months for tacrolimus, respectively. During the observational period, 37 patients died (21 patients died of cancer) and 51 patients were still alive (7 grafts failed). CONCLUSIONS: The incidence of malignancy after renal transplantation increases according to the longer follow-up period. An active screening program is needed to lower the incidence of malignancy in renal transplant recipients.
Azathioprine ; Carcinoma, Renal Cell ; Cervix Uteri ; Cyclosporine ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Incidence* ; Kidney ; Kidney Transplantation ; Lymphoma ; Male ; Mass Screening ; Prognosis ; Retrospective Studies ; Sarcoma, Kaposi ; Stomach Neoplasms ; Tacrolimus ; Thyroid Neoplasms ; Transplantation* ; Transplants

Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diabetes Mellitus ; Dialysis ; Drug Therapy ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis C ; Humans ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Liver ; Liver Failure ; Polycystic Kidney Diseases ; Tacrolimus ; Transplantation

Purpose: The present study aims to determine the clinical outcome of kidney transplantation and to provide data of long-term graft and patient survival. Methods: Between 1969 and 2005, 1,500 kidney transplants were performed at the Kangnam st. Mary's hospital. We analyzed the clinical characteristics and outcomes of kidney transplant recipients retrospectively. Results: The mean follow-up period was 112 months. Chronic glomerulonephritis was the leading cause of primary renal diseases, but the proportion of has increased from 1 % before 1985 to 6% afterwards. First renal transplantation was 94.5% (n=1418), and retransplantation was 5.4% (n=82). Type of donor source was mostly living-related, with the recent decrease in the number of living- unrelated donors. Currently, 72l patients are alive with functioning grafts, 297 cases had graft failure, 277 cases died, 205 cases were transferred or lost during follow-up. Main cause of graft failure was chronic allograft nephropathy (n=316). Overall, 1-, 5-, 10-, and 20-year graft survival were 92%, 81%, 66%, and 29% respectively. 1-, 5-, 10-, and 20-year patient survival were 93%, 88%, 81%, and 69% respectively. Conclusion: This review of 36-years experience in a single center showed that the graft survival has improved compared to the initial transplantation era.
Allografts ; Follow-Up Studies ; Glomerulonephritis ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Korea* ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplantation ; Transplants ; Unrelated Donors

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Korea* ; Mortality ; Questionnaires* ; Rupture ; Treatment Outcome

Superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by SMA. There are many causes leading to the SMA syndrome, however it's extremely rare that aortic aneurysm causes a SMA syndrome. We report a case of a successfully treated SMA syndrome due to an abdominal aortic aneurysm in a renal transplant recipient. The patient was a 52-yr-old woman with a thin stature (weight 40 kg, height 164 cm). She received a renal transplant 8 yr before, and had hypertension and abdominal aortic aneurysm. Her SMA syndrome developed in a prolonged supine position for the accidental rib fractures and was diagnosed by clinical and radiological findings. After a surgical correction (resection of an aneurysm and aortobiiliac bypass with an inverted Y graft), her symptoms relieved without deterioration of the graft function.
Aortic Aneurysm, Abdominal/*complications/surgery ; Duodenal Obstruction ; Duodenum/radiography ; Female ; Humans ; *Kidney Transplantation ; Middle Aged ; Superior Mesenteric Artery Syndrome/*etiology/surgery ; Tomography, X-Ray Computed

OBJECTIVES: Parents of child neuropsychiatic patients may have many stresses due to their children's illness. Characteristics and severity of diseases will influence to the stresses of parents. The authors investigated various factors and parents' social support having an effect on the parenting stress. METHODS: Children and parents in outpatients interviewed and completed measures assessing children's problem behaviors, parenting stress, general social support, and support related to parenting by Child Behavior Checklist, Parenting Stress Index, Medical Outcomes Study's Social Support Scale, and Parenting Support Scale. RESULTS: We could not find the differences in the total scores of CBCL, Social Support Scale, and Parenting Stress Index among major diagnostic groups. In the same diagnosis, no difference of parenting stress was found according to general social support. Parenting stress highly correlated with severity of problem behaviors measured by CBCL. CONCLUSION: Severity of problem behaviors perceived by parents most predicted parenting stress. Parenting stress correlated with support to parenting, but not with general social support. Managing of children's problem behaviors is the most immediate and effective method to diminish the parental stress of child neuropsychiatric patients.
Checklist ; Child Behavior ; Child* ; Diagnosis ; Humans ; Outpatients* ; Parenting* ; Parents*

PURPOSE: Recombinant Interferon-alpha (rIFN-alpha) treatment is effective in treating chronic hepatitis C in the patients with end stage renal disease, and is also effective in preventing reactivation of hepatitis C virus (HCV) after renal transplantation. We here report our experience of rIFN-alpha treatment in renal transplant recipients and dialysis patients awaiting transplantation. METHODS: Total nine patients were enrolled. Four patients (2 Hemodialysis patients, 2 Peritoneal dialysis patients) were on waiting lists for renal transplantation and five patients were renal transplant recipients. All the patients were HCV antibody and HCV RNA positive with elevated ALT more than normal limit for at least 6 months. Five renal transplant recipients had stable renal function for at least 6 months. rIFN-alpha at a dose of 3 million units was administered by subcutaneous injection three times a week for 6 months. Two renal transplant recipient received rIFN-alpha in combination with ribavirin (600 mg orally per day). RESULTS: At the end of treatment, the rate of virological response (negative conversion of HCV RNA) was 67% (6/9 cases), and biochemical response (normalized ALT) was 88% (8/9 cases). The virological responders showed sustained loss of HCV RNA (sustained virological response 67%). and 7 out of 8 biochemical responder had normal ALT during follow-up period (sustained biochemical response 77%). Two patients who showed negative conversion of HCV RNA in the pre- renal transplantation period showed sustained loss of HCV RNA and normal ALT over post-renal transplantation period. There was no irreversible renal failure and acute rejection episode in renal transplant recipients during treatment of rIFN-alpha except one recipient with reversible and mild renal dysfunction, but two case of combination therapy of rIFN-alpha and ribavirin had hemolytic anemia. CONCLUSION: The rIFN-alpha therapy in pre-transplant patients may appear to exert a beneficial effect of the liver disease following renal transplantation and irreversible renal failure does not develop in renal transplant recipients.
Anemia, Hemolytic ; Dialysis ; Follow-Up Studies ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Injections, Subcutaneous ; Interferon-alpha* ; Interferons* ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver Diseases ; Peritoneal Dialysis ; Renal Dialysis ; Renal Insufficiency ; Ribavirin ; RNA ; Transplantation ; Waiting Lists

PURPOSE: The aim of this study was to evaluate the clinical course of chronic viral hepatits in renal transplant recipients. METHODS: During the period from January 1980 to December 1998, a total of 1122 cases of kidney transplantation (KT) were performed at the Kangnam St. Mary's Hospital. Eighty- one transplant recipients received azathioprine (AZA) and 1041 transplant recipients received cyclosporin A (CsA). We tested hepatitis B surface antigen (HBS Ag) and hepatitis C virus antibody (HCV Ab). According to duration of hepatic dysfunction, radiologic examination and liver biopsy, clinical course of hepatitis was classified; (1) Health carrier: HBs Ag or HCV Ab positive with normal laboratory finding. (2) Chronic hepatitis: clinical and/or laboratory evidence of hepatic dysfunction that persisted more than 6 months. (3) Liver cirrhosis and hepatocellular carcinoma (HCC); liver ultrasonography, abdominal CT and liver biopsy. RESULTS: (1) The patients with HBs Ag positive were 117 cases (10.4%). Sixteen cases died within 1 year after KT because of hepatic failure or other complication. We followed up 101 cases. Sixty-seven cases (66.4%) were health carrier and two of them progressed to HCC. Thirty-four cases (33.5%) developed chronic hepatitis B and liver cirrhosis was developed in 10 cases (29.4%). (2) Because of availability of diagnostic method, 877 cases were tested for HCV Ab. The patients with HCV Ab positive were 94 cases (10.7%). Four cases died within 1 year after KT. Thirteen cases (13.8%) were both HBs Ag and HCV Ab positive. We followed up 75 cases only HCV Ab positive. Fifty-three cases (70.7%) were health carrier and 22 cases (29.3%) progressed to chronic hepatitis C. Any case did not progressed to liver cirrhosis or HCC. (3) Eight cases of HCC were developed from chronic hepatitis B, and one case was both HBs Ag and HCV Ab negative. Among these, male gender is predominant (male : female=7 : 2). The average age at KT were 37.9 years. HCC was diagnosed at 102.6 (range 44 to 173) months after KT. Eight cases received CsA and prednisolone and only 1 case received AZA and prednisolone. Two cases underwent surgical intervention and the other 7 cases treated with transarterial chemoembolization and chemotherapy. The average survival was 10.4 (1 to 40) months, 3 cases are still alive. CONCLUSION: Clinical course of HCV infection is less aggressive than that of HBV infection in renal transplant recipients.
Azathioprine ; Biopsy ; Carcinoma, Hepatocellular ; Cyclosporine ; Drug Therapy ; Hepacivirus ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Kidney Transplantation ; Liver ; Liver Cirrhosis ; Liver Failure ; Male ; Prednisolone ; Tomography, X-Ray Computed ; Transplantation* ; Ultrasonography