Spinal subdural hematoma is a rarely reported disease and spontaneous spinal subdural hematomas (SSDH) without underlying pathological changes are even rarer. The patients usually show typical symtoms such as back pain, quadriplegia, paraplegia or sensory change. But rarely, patients may show atypical symptoms such as hemiparesis and misdiagnosed to cerebrovascular accident. We recently experienced a case of SSDH, where the patient initially showed vague symptoms, such as the sudden onset of headache which we initially misdiagnosed as subarachnoid hemorrhage. In this case, the headache of patient improved but the neck pain persisted until hospital day 5. Therefre, we conducted the MRI of cervical spine and finally confirmed SSDH. The patient was managed conservatively and improved without recurrence. In this case report, we discuss the clinical features of SSDH with emphasis on the importance of an early diagnosis.
Back Pain ; Diagnosis ; Early Diagnosis ; Headache ; Hematoma, Subdural, Spinal* ; Humans ; Magnetic Resonance Imaging ; Neck Pain ; Paraplegia ; Paresis ; Quadriplegia ; Recurrence ; Spine ; Stroke ; Subarachnoid Hemorrhage

Spinal subdural hematoma is a rarely reported disease and spontaneous spinal subdural hematomas (SSDH) without underlying pathological changes are even rarer. The patients usually show typical symtoms such as back pain, quadriplegia, paraplegia or sensory change. But rarely, patients may show atypical symptoms such as hemiparesis and misdiagnosed to cerebrovascular accident. We recently experienced a case of SSDH, where the patient initially showed vague symptoms, such as the sudden onset of headache which we initially misdiagnosed as subarachnoid hemorrhage. In this case, the headache of patient improved but the neck pain persisted until hospital day 5. Therefre, we conducted the MRI of cervical spine and finally confirmed SSDH. The patient was managed conservatively and improved without recurrence. In this case report, we discuss the clinical features of SSDH with emphasis on the importance of an early diagnosis.
Back Pain ; Diagnosis ; Early Diagnosis ; Headache ; Hematoma, Subdural, Spinal* ; Humans ; Magnetic Resonance Imaging ; Neck Pain ; Paraplegia ; Paresis ; Quadriplegia ; Recurrence ; Spine ; Stroke ; Subarachnoid Hemorrhage

OBJECTIVE: The presence of a cerebral aneurysm remnant after surgical clipping is associated with a risk of regrowth or rupture. For these recurred aneurysms, coil embolization can be considered as a treatment option. We retrospectively reviewed cases of ruptured or regrown aneurysms after clipping treated by endovascular coil embolization. MATERIALS AND METHODS: We conducted a retrospective review of patients with ruptured or recurred aneurysm after clipping, who underwent coil embolization between January 1995 and December 2013. We evaluated clinical information and the outcomes of these cases. RESULTS: Eight patients were treated by endovascular coil embolization after surgical clipping. Six aneurysms were located in the anterior communicating artery, one in the posterior communicating artery, and one in the middle cerebral artery bifurcation. All patients were initially treated by surgical clipping because of a ruptured aneurysm. Aneurysm recurrence at the initial clipping site was detected in all cases. The median interval from initial to second presentation was 42 months. In four patients, aneurysms were detected before rupture and the four remaining patients presented with recurrent subarachnoid hemorrhage. All patients were treated by coil embolization and showed successful occlusion of aneurysms without complications. CONCLUSION: Endovascular coil embolization can be a safe and successful treatment option for recurred aneurysms after clipping.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Embolization, Therapeutic* ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Recurrence ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Surgical Instruments

BACKGROUND/OBJECTIVES: The purpose of this study was to examine whether plasma lipid profiles are affected differently by snack kinds with equal calorific values. SUBJECTS/METHODS: We compared a Korean traditional confectionery (dasik) with Western confectionery (cookie) in this regard. Controlled cross-over study consisted of two 3-week snack intake phases and for separating, a 2-week washout period (3–2–3) was carried out with 30 healthy women aged between 40-59 years old. Brown rice based Korean traditional confectionery and wheat flour based Western confectionery were used. The participants consumed either dasik or cookie every day for 3 weeks, providing 93 kcal a day. RESULTS: The total cholesterol (TC) in the dasik group had decreased significantly after 3 weeks (P < 0.05). Furthermore, in the dasik group, reduction in TC and low-density lipoprotein-cholesterol were greater than those in the cookie group (P < 0.05). CONCLUSIONS: Prioritizing functional snacks like dasik improves plasma lipid profiles; this may be useful information for individuals who cannot refrain from snacking.
Cholesterol ; Cross-Over Studies* ; Female ; Flour ; Humans ; Plasma* ; Snacks ; Triticum

Objective: Endoscopic hemostasis is a key treatment for variceal upper gastrointestinal bleeding. However, the effects of early endoscopy in variceal upper gastrointestinal bleeding have not been sufficiently studied. This study investigated the effects of the use of the critical pathway (CP) for upper gastrointestinal bleeding. Methods: The study was designed as a ‘before and after’ study. A group of patients diagnosed with variceal upper gastrointestinal bleeding from January 1, 2011, to December 31, 2014, and CP activated patients from January 1, 2015, to December 31, 2018, were reviewed retrospectively. The study endpoints included an analysis of the following in the two groups: time from emergency department (ED) arrival to endoscopy, number of blood transfusions, hospitalization period, intensive care unit (ICU) admission, 30-day mortality. Results: From January 1, 2011, to December 31, 2018, 207 patients were admitted with variceal upper gastrointestinal bleeding, and 137 patients with a Blatchford score of 7 or higher were included in the study. Of these, 88 patients visited before the implementation of CP and 49 patients visited thereafter. The time from ED arrival to endoscopy was 218.1±201.7 minutes in the CP activated group, which was about 200 minutes shorter (P=0.046) than the non-CP group. There was no statistical difference in 30-day mortality, transfusion, emergency room hospitalization time, number of ICU admissions, and hospitalization days (P=0.348, P=0.394, P=0.651, P=0.164, and P=0.069). Conclusion After CP, the time to endoscopy was significantly shortened, but it did not reduce mortality.

OBJECTIVE: This study examined the prevalence and correlates of depressive symptoms in North Korean defectors who have been living in South Korea for more than one year. METHODS: We used questionnaires developed by the authors to collect sociodemographic data in addition to the Center for Epidemiologic Studies Depression Scale (CES-D), the Psychosocial Well-being Index to measure stress, and a social support scale. A total of 367 subjects were included in this study. RESULTS: The results showed that 30.5% of the men and 34.7% of the women reported depressive symptoms, and 33.1% of the men and 36.1% of the women exhibited signs of severe distress. Correlates of depressive symptoms were lack of occupation [odds ratio (OR)=2.198, 95% confidence interval (CI), 1.247-3.873], having escaped without family (OR=1.725, 95% CI, 1.006-2.959), and a poor subjective sense of health status (OR=3.111, 95% CI, 1.591-6.085). CONCLUSION: Continuing vocational training and career management, psychological support programs, and intensive physical health services are needed to improve the mental health of this population.
Depression ; Epidemiologic Studies ; Female ; Health Services ; Humans ; Male ; Mental Health ; Occupations ; Prevalence ; Surveys and Questionnaires ; Republic of Korea ; United Nations

BACKGROUND: The average dietary sodium intake of Koreans is 2.6 times higher than the World Health Organization's recommended amount. The effect of a diet high in sodium on the skeletal system, especially osteoporosis, has not previously been examined in Korean postmenopausal women with low bone mass. We assessed the daily sodium intake, and determined the impact of sodium intake on urinary calcium excretion and bone resorption marker. METHODS: A retrospective review of medical records was performed for 86 postmenopausal subjects who were initially diagnosed with osteopenia or osteoporosis at the health promotion center. They were subsequently referred to the Division of Endocrinology and Metabolism between 2010 and 2013. All subjects completed a modified food frequency questionnaire. Twenty-four hour urine collection for sodium, calcium and creatinine excretion, and serum C-terminal telopeptides of type I collagen (CTX-I) were also obtained. RESULTS: The average amount of daily sodium and calcium intake were 3,466 mg and 813 mg, respectively. Average dietary sodium intake and 24-hour urinary sodium excretion showed significant positive linear correlation (r=0.29, P=0.006). There was also a significant positive linear correlation between 24-hour urine sodium and calcium excretion (r=0.42, P<0.001); CTX-I and 24-hour urinary calcium excretion (r=0.29, P=0.007). CONCLUSIONS: Excessive sodium intake assessed by 24-hour urine specimen is associated with high calcium excretion in urine. High calcium excretion is also related to increasing bone resorption marker.
Bone Diseases, Metabolic ; Bone Resorption* ; Calcium* ; Collagen Type I ; Creatinine ; Diet ; Endocrinology ; Female ; Health Promotion ; Humans ; Medical Records ; Metabolism ; Osteoporosis ; Retrospective Studies ; Sodium ; Sodium, Dietary* ; Urine Specimen Collection ; World Health ; World Health Organization ; Surveys and Questionnaires