Acute basilar artery (BA) occlusion is a key etiology of devastating posterior circulation stroke, unless recanalization is performed early. Recanalization therapy is determined synthetically based on symptom onset time, stroke severity, and brain imaging. Herein, we report the case of a 72-year-old male patient presenting with minor neurological symptoms, but with thrombotic occlusion at the BA tip. Transcranial Doppler (TCD) showed systolic flow reversal along the vertebrobasilar arteries, and the patient benefited from endovascular thrombectomy. This case highlights the critical role of TCD in identifying hemodynamic insufficiency and determining the implementation of endovascular interventions to mitigate stroke progression.

Acute basilar artery (BA) occlusion is a key etiology of devastating posterior circulation stroke, unless recanalization is performed early. Recanalization therapy is determined synthetically based on symptom onset time, stroke severity, and brain imaging. Herein, we report the case of a 72-year-old male patient presenting with minor neurological symptoms, but with thrombotic occlusion at the BA tip. Transcranial Doppler (TCD) showed systolic flow reversal along the vertebrobasilar arteries, and the patient benefited from endovascular thrombectomy. This case highlights the critical role of TCD in identifying hemodynamic insufficiency and determining the implementation of endovascular interventions to mitigate stroke progression.

Acute basilar artery (BA) occlusion is a key etiology of devastating posterior circulation stroke, unless recanalization is performed early. Recanalization therapy is determined synthetically based on symptom onset time, stroke severity, and brain imaging. Herein, we report the case of a 72-year-old male patient presenting with minor neurological symptoms, but with thrombotic occlusion at the BA tip. Transcranial Doppler (TCD) showed systolic flow reversal along the vertebrobasilar arteries, and the patient benefited from endovascular thrombectomy. This case highlights the critical role of TCD in identifying hemodynamic insufficiency and determining the implementation of endovascular interventions to mitigate stroke progression.

Acute basilar artery (BA) occlusion is a key etiology of devastating posterior circulation stroke, unless recanalization is performed early. Recanalization therapy is determined synthetically based on symptom onset time, stroke severity, and brain imaging. Herein, we report the case of a 72-year-old male patient presenting with minor neurological symptoms, but with thrombotic occlusion at the BA tip. Transcranial Doppler (TCD) showed systolic flow reversal along the vertebrobasilar arteries, and the patient benefited from endovascular thrombectomy. This case highlights the critical role of TCD in identifying hemodynamic insufficiency and determining the implementation of endovascular interventions to mitigate stroke progression.

PURPOSE: The aim of this study un to determine factors that affect Emergency department (ED) Length of Stay (LOS) in patients with orbital wall fracture. METHODS: We retrospectively analyzed orbital fracture patients who visited our ED from January 1, 2012 to December 31, 2013. Patients'data, including sex, age, mechanism of injury, site of fracture, associated injury, physical finding, CT finding, and intra-ocular injuries were recorded. LOS was divided into three phases (Pre-consultation time, Consultation waiting time, Consultation time). We performed analysis to determine the factors associated with LOS. We also performed analysis to determine the factors associated with severe intraocular injury (SIOS). RESULTS: A total of 154 patients (160 eyes) were included. Orbital fractures were more frequent in males. The most common cause of orbital fracture was violence. LOS was 290.0 (IQR 200.0~465.0) min, pre-consultation time was 36.0 (IQR 22.0~61.0) min, consultation waiting time was 64.0 (IQR 34.0~128.0) min, and consultation time was 152.0 (IQR 87.0~245.0) min. Violence, alcohol consumption, consultation with plastic surgeon, and consultation with ophthalmologist showed association with prolonged LOS (p<0.001, p<0.001, p=0.04, p<0.001). Violence and alcohol consumption affected consultation waiting time (p<0.001, p<0.001) and consultation time (p=0.04, p<0.001). Consultation with a plastic surgeon and consultation with an ophthalmologist affected consultation time (p=0.03, p<0.001). Patients with symptoms including blindness, blurred vision, and visual field defect showed significant association with SIOS (Odd ratio=14.08). CONCLUSION: Violence, alcohol consumption, and consultations with specialists showed significant association with LOS.
Alcohol Drinking ; Blindness ; Emergency Service, Hospital* ; Humans ; Length of Stay* ; Male ; Orbit* ; Orbital Fractures ; Referral and Consultation ; Retrospective Studies ; Specialization ; United Nations ; Violence ; Visual Fields

Of the congenital coronary artery fistulae, the multiple coronary artery microfistulae, arising from the left and right coronary artery emptying into the left ventricle, are very rare. Little is known about their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. The clinical findings are heterogeneous, but include, in most cases, a history of typical or atypical angina pectoris. A 67 year old woman was referred for evaluation of chest pain on exertion, and a shortness of breath. The electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic Doppler echocardiography, using a high frequency transducer, with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.
Aged ; Angina Pectoris ; Angiography ; Cardiomyopathy, Hypertrophic ; Chest Pain ; Coronary Vessels ; Dyspnea ; Echocardiography ; Echocardiography, Doppler* ; Electrocardiography ; Female ; Fistula ; Heart Ventricles ; Humans ; Transducers ; Vascular Fistula

With the widespread use of broad-spectrum antibiotics in clinical practice, the emergence of multidrug-resistant (MDR) gram-negative bacteria has become a global problem. The MDR Pseudomonas aeruginosa infection is especially difficult to treat and increases mortality in critically ill patients. Ceftolozane-tazobactam (Zerbaxa™) is a fifth-generation cephalosporin and beta-lactamase inhibitor that has proved to be effective for treating complicated urinary tract infections and complicated intra-abdominal infections caused by MDR P. aeruginosa. Herein, we report the first case of pediatric hematologic cancer in Korea that was successfully treated for MDR P. aeruginosa bacteremia with Ceftolozane-tazobactam.

As of April 18, 2020, there have been a total of 10,653 confirmed cases and 232 deaths due to coronavirus disease 2019 (COVID-19) in Korea. The pathogen spread quickly, and the outbreak caused nationwide anxiety and shock. This study presented the anecdotal records that provided a detailed process of the multidisciplinary teamwork in mental health during the COVID-19 outbreak in the country. Psychosocial support is no less important than infection control during an epidemic, and collaboration and networking are at the core of disaster management. Thus, a multidisciplinary team of mental health professionals was immediately established and has collaborated effectively with its internal and external stakeholders for psychosocial support during the COVID-19 outbreak.