OBJECTIVE: This study was done to evaluate the risk factors associated with recurrence after first-ever stroke. METHOD: We retrospectively studied 256 first-ever stroke patients treated in Dong-Eui hospital from March 1997 to February 1998. Telephone or out-patient interviews were performed with these patients regarding stroke recurrence and treatment for hypertension and diabetes mellitus. These were divided into two groups, those with recurrence and those without. Evaluated risk factors for stroke recurrence were the following: history of diabetes mellitus, hypertension, heart disease, smoking, alcohol drinking, and transient ischemic attack; clinical findings at admission of hypertension, diabetes mellitus, hyperlipidemia, heart disease, type and location of stroke; treatment compliance for diabetes mellitus and hypertension after discharge. RESULTS: The recurrence rate after first-ever stroke was 12.9%. In univariate analysis, significant risk factors for stroke recurrence were history of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge (p<0.05). In multivariate analysis, significant risk factors for stroke recurrence were atrial fibrillation at admission (odds ratio=3.43) and non-compliance with therapy for hypertension after discharge (odds ratio=7.51)(p<0.05). CONCLUSION: History of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge are considered to be important factors for recurrence of stroke. So treatment and education for those factors associated with stroke recurrence are needed during rehabilitation program.
Alcohol Drinking ; Atrial Fibrillation ; Compliance ; Diabetes Mellitus ; Education ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Ischemic Attack, Transient ; Multivariate Analysis ; Myocardial Ischemia ; Outpatients ; Recurrence* ; Rehabilitation ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Stroke* ; Telephone

OBJECTIVE: The purpose of this study is to evaluate the patterns of voiding dysfunction of stroke patients during rehabilitation. METHOD: We evaluated 53 patients with complaints of voiding dysfunction following the strokes. After the comprehensive history and physical examination, all patients underwent cystometric study and males underwent the transrectal ultrasound. RESULTS: The incidences of detrusor hyperreflexia, detrusor areflexia, and normal finding on the cystometry were 50.9%, 32.1%, and 17.0%, respectively (p<0.05). There was a significantly high incidence of detrusor hyperreflexia in the groups of subcortical lesion, large lesion, and the over 3 months after stroke (p<0.05). However, there was no statistical difference on cystometric findings according to the other characteristics of the stroke such as the age, sex, type of stroke, cognition, aphasia, and diabetes mellitus. The incidences of irritative, obstructive, and mixed symptoms according to the presenting voiding complaints were 49.1%, 32.1%, and 18.9%, respectively (p<0.05). There was no significant statistical difference on the cystometric findings according to the 3 voiding symptom groups as well as none of significant statistical difference on prostate enlargement in males in according to the 3 voiding symptom groups. CONCLUSION: Only with the pattern of voiding, we could not predict the cystometric finding or the presence of bladder outlet obstruction. Thus, we recommend the further studies including cystometry and evaluation of the bladder outlet obstruction for the treatment of voiding dysfunction of stroke patients during rehabilitation.
Aphasia ; Cognition ; Diabetes Mellitus ; Humans ; Incidence ; Male ; Physical Examination ; Prostate ; Reflex, Abnormal ; Rehabilitation* ; Stroke* ; Ultrasonography ; Urinary Bladder Neck Obstruction

The purpose of this study is to develop the computerized health instruction system to manage the Health Management Members(HMM) of the Gangbook-ku Health center in Seoul who have registered for the life-time health promotion. The HMM have been checked up and classified into 3 groups - healthy, borderline and ill group - based on their health assessment data through the computerized management system. But the computerized supporting programs for intensive management have not been sufficient enough to offer clear health instructions to the HMM and more than one user in the health center have not been able to use the system at the same time. Therefore, we have developed some new health instruction programs and upgraded the system to be used concurrently. For that purposes, we have used Delphi, Microsoft Access, ActiveX Data Objects(ADO) technology as development tools. We expect thi system to be used for health management of other public health centers, schools, and occupational settings, furthermore for evaluation of health promotion services. Additionally, this new computerized health management system supplemented with health instruction programs should be integrated to the computerized health care system at health centers in near future.
Delivery of Health Care ; Health Promotion ; Humans ; Public Health ; Seoul

Ketoprofen is an nonsteroidal anti-inflammatory drug derived from propionic acid. It has been widely used as topical preparations, as gel or patch. It has been reported that topical ketoprofen can cause contact dermatitis and photocontact dermatitis. We experienced five cases of contact dermatitis, developed after applying ketoprofen patch(Ketotop(R), Pacific pharmaceutical Co., Korea) for the control of oste omuscular or joint pain. While one patient had generalized urticarial eruption, the rest of patents showed localized erythematous pruritic eczematous skin eruptions. It was verified through intradermal skin test and pin prick test that ketoprofen itself was not the causative drug for the skin eruption. Patch test excluded the possibility of allergic skin reaction to rubber compounds. It should be elucidated which compounds are allergic or toxic to the skin, contained in woven fabrics.
Arthralgia ; Dermatitis, Contact* ; Dermatitis, Photoallergic ; Diethylpropion ; Humans ; Ketoprofen* ; Patch Tests ; Rubber ; Skin ; Skin Tests

BACKGROUND: Nettles, of the plant family Urticae, cause nonimmunologic contact urticaria by stinging hairs. Light application of the leaf or stem to the skin results in the rapid development of a short-lived stinging sensation accompanied by wheal formation and itching. The types of chemical mediators causing the stinging sensation and wheal have not yet been clarified. OBJECTIVE: To investigate stinging and urticating substances causing contact urticaria when the skin is in contact with nettle(Urtica thunbergiana). METHODS: Twenty two volunteers were used for the clinical portion of this investigation. The time to wheal development and the evanescent time of pain and wheal were measured after pricking the forearm skin with nettle trichomes, following the administration of antihistamine, antiserotonin or corticosteroid, respectively or a combination of two, either with or without the application of substance P antagonist(capsaicin cream, 0.025%). Nettle extracts were prepared from dry stems and leaves of Urtica thunbergiana. Histamine, serotonin and substance P(SP) contents of nettle extracts were measured by gas chromatographic mass spectroscopy. RESULTS: After puncture of the skin by trichome of nettle, a stinging sensation developed within a few seconds but disappeared faster at the site where capsaicin cream had been applied than at the nonapplied skin site(p<0.05). The development and evanescent time of wheal were not significantly correlated with the application of capsaicin cream. The evanescent time of pain after pricking the skin with trichome following the administration of antiserotonin was significantly shortened at the nonapplied skin site. Pain disappeared more rapidly at the capsaicin applied site following the administration of antihistamine or antiserotonin than at the nonapplied sites(p<0.05), but not following prednisolone administration. Wheal development was delayed significantly at both the capsaicin applied and nonapplied sites after antihistamine administration(p<0.05). Histamine was detected only in the nettle extract. SP and serotonin were not detected because of their insolubility in solvents. CONCLUSION: These results suggest that wheal-and-flare reaction to nettle stings is due primarily to the histamine and partly to the serotonin and SP introduced by the nettle. SP may be mainly involved and partially involved by serotonin in stinging pain.
Bites and Stings ; Capsaicin ; Forearm ; Hair ; Histamine ; Humans ; Mass Spectrometry ; Plants ; Prednisolone ; Pruritus ; Punctures ; Sensation ; Serotonin ; Skin ; Solvents ; Substance P ; Trichomes ; Urticaria* ; Volunteers

OBJECTIVE: To investigate the clinical characteristics, risk factors and complications of stroke patients and their effect on the patient's functional outcomes at discharge. METHOD: We performed a prospective study during hospitalization on 1, 250 consecutive acute stroke patients discharged from Dong-Eui Hospital from June 2001 to May 2002. Glasgow outcome scale, status of upper extremity involved and status of ambulation were used to evaluate functional status. RESULTS: The variables of clinical characteristics identified as significant in functional status at discharge were the presence of occupation, interval between onset and visit to hospital arrival, type of first treatment after stroke, type of caregiver, type of stroke and location of infarction and intracranial hemorrhage. Positive functional outcomes were significantly related to a younger age, male, small amount of hemorrhage and short length of hospital stay. Among risk factors of stroke, abnormal ECG findings at admission and presence of previous stroke were negative prognostic factors. The complications influencing stroke outcome negatively were pneumonia, depression, urinary tract infection, myocardial infarction and recurrence of stroke in hospitalization. CONCLUSION: The results of this study should be considered during acute management and rehabilitation of stroke patients and are valuable as basic data of functional outcome after stroke.
Caregivers ; Depression ; Electrocardiography ; Glasgow Outcome Scale ; Hemorrhage ; Hospitalization ; Humans ; Infarction ; Intracranial Hemorrhages ; Length of Stay ; Male ; Myocardial Infarction ; Occupations ; Pneumonia ; Prospective Studies ; Recurrence ; Rehabilitation ; Risk Factors ; Stroke* ; Upper Extremity ; Urinary Tract Infections ; Walking

Hoffa's disease refers to inflammation, subsequent hypertrophy and impingement of the infrapatellar fat pad, and this is all triggered by acute trauma or repetitive microtrauma. Patients with Hoffa's disease manifest with anterior knee pain and functional impairment. The chronic impingement of the infrapatellar fat pad, which contains many progenitor cells, may promote fibrocartilaginous formation and osteochondral metaplasia of adipose tissue, so osteochondroma is sometimes found in patients with advanced Hoffa's disease. We report here on an ossifying chondrolipoangioma as an advanced form of Hoffa disease that occurred in the infrapatellar fat pad.
Adipose Tissue ; Humans ; Hypertrophy ; Inflammation ; Knee ; Metaplasia ; Osteochondroma ; Stem Cells

PURPOSE: To evaluate the results of the treatment of the supracondylar fractures of the humerus according to the fixation methods with cannulated screw. MATERIALS AND METHODS: Eight patients, aged 49 to 82 years (average, 65 years), were reviewed after a mean follow-up of 16 months (range, 12~24 months). According to AO classification all fractures were classified as type A2 (simple transverse supracondylar fracture). All patients underwent closed reduction. Percutaneous fixation with cannulated screws was performed in 8 patients. Three of 8 patients had associated medical problems and one patient had distal radius fracture. The functional results were assessed by the Mayo Elbow Performance Score. RESULTS: Mean operation time was 59 minutes (45~75) and all the patients with cannulated screw fixation had bony union and were able to early ROM exercise. Mean ranges of motion was 5~120 degrees with excellent functional results. Functional evaluation of elbow joint by Mayo method showed mean value of 88 (75~95). CONCLUSION: The cannulated screw fixation of supracondylar fracture of humerus, especially in the elderly aged group with medical disease had excellent functional results (rigid fixation & early ROM exercise) due to shortening of surgery time and anesthesic time, combined with decreased technical difficulties of the surgical procedure
Aged ; Classification ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Humerus* ; Methods ; Radius Fractures

PURPOSE: The GlideScope video laryngoscope (GL) has been known to help inexperienced health care providers become able to manage even difficult airways. The purpose of this study was to compare foreign body removal efficacies between the Macintosh laryngoscope (ML) and the GL in a setting of airway obstruction. METHODS: Participants were asked to remove the simulated foreign body (2x2 cm rice cake) from the supraglottic area of a freshly embalmed cadaver. This simulated a normal airway and a difficult airway with cervical spine immobilization. Participants performed the removal maneuver 4 times in random order using a Magill forceps with both the ML and the GL. We measured the time to removal (sec) and preference of the participant (5-point scale) and compared results according to the type of laryngoscope. Successful removal was defined as a removal time that was less than 120 sec. RESULTS: Forty participants were enrolled in this simulation experiment. The success rate, time to removal and provider preference were not significantly different betweeh the two types of laryngoscope. In subgroup analysis for experienced providers, the time to removal was significantly shorter in the ML group than the GL group (14 vs 20 sec, p<0.05). The preference of experienced provider was also significantly higher for ML than GL. CONCLUSION: This study suggests that ML has comparable efficacy for foreign body removal to GL and is acceptable to experienced providers.
Airway Obstruction ; Cadaver ; Foreign Bodies ; Health Personnel ; Humans ; Immobilization ; Laryngoscopes ; Spine ; Surgical Instruments

Purposes: Although the standard management of limited stage small cell lung cancer is concurrent platinum-based chemotherapy with thoracic radiotherapy (TRT), the optimal timing of the TRT remains controversial. We investigated the feasibility of concurrent chemoradiation for the patients with limited stage small cell lung cancer after 2 cycles of combination chemotherapy with Etoposide/Cisplatin (EP). MATERIALS AND METHODS: EP consisted of Etoposide 100 mg/m2 on day 1 to 3 and Cisplatin 70 mg/m2 on day 1. Six cycles were given to the responders every 4 weeks. Total 55 Gy (1.8 Gy once-daily or 1.2 Gy twice-daily, 5 days per week) of TRT were given to the patients who showed at least a partial response after 2 cycles of EP. The other patients were treated by the physician's decision. The patients with complete remission were recommended to receive prophylactic cranial irradiation. RESULTS: Fifty patients were enrolled. Thirty-five (70%) of them showed responses (2 complete remissions and 33 partial remissions) after 2 cycles of EP. Thirty-three of the responders were given TRT starting with the 3rd cycle of EP. The nonresponders were treated with salvage chemotherapy and TRT. After completion of treatment for 50 patients, the overall response rate was 86% (29 complete remissions, 14 partial remissions). One patient (2%) showed stable disease, and 6 (12%) showed a progressive disease. The median progression free survival was 326 days and the median survival time was 410 days. One-, 2-, 3-, 4- and 5-year survival rates were 62%, 24%, 14%, 9% and 6%, respectively. As hematologic toxicities during chemoradiation, 35.1% with grade III/IV neutropenia and 18.9% with grade III/IV thrombocytopenia were noted. Grade II/III radiation pneumonitis and radiation esophagitis were noted in 5/1 and 13/1 patients (15.2%/ 3.0% and 39.4%/3.0%), respectively. One patient died of septicemia during chemoradiation. CONCLUSION: The concurrent EP and TRT after 2 cycles of EP was feasible in limited stage small cell lung cancer. Further study is required for the indentification of optimum timing of TRT during combination chemotherapy.
Chemoradiotherapy ; Cisplatin ; Cranial Irradiation ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Esophagitis ; Etoposide ; Humans ; Neutropenia ; Radiation Pneumonitis ; Radiotherapy* ; Sepsis ; Small Cell Lung Carcinoma* ; Survival Rate ; Thrombocytopenia