The authors reviewed the medical records of 103 patients who were diagnosed and treated as myasthenia gravis (MG)at Seoul National University Hospital from March 1979 to March 1984. Among them 16 cases were selected according to the criteria of crisis in MG defined by Blaugrund SM et al(1964) and were studied with a special emphasis on crisis as a natural course of MG in Korea. The authors studied about the incidence of crisis, the aggravating factors or causes, the relationship between crisis and thymus pathology, and the clinical appllcability of the modified classification of crises in MG including a newly-defined steroid-inducd crisis. The results were not significantly different from those by others in general. The incidence rate of crisis was 16% and highest in the female group having the onest of MG in the fourth decade of life. Four patients(25%) had thymomas(2, noninvasive: 2, invasive). The intervals between the onset of MG and the first crises were significantly shorter in male patients and thymoma group, showing the more fulminant course in them. Some probable risk factors were suggested, though not analyzed statistically, which might foretell the prognosis of each patient having MG and might help management and prevention of crisis. They were as follows: (1) Female with onset of MG in her fourth decade, (2) Male with duration less than one year, (3) Patient with thymoma, (4) Patient classified into Osserman's group III, (5) Patient with brittle MG, (6) Patient with an infectious process, especially with repiratory infection Early detection of respiratory insufficiency, intensive respiratory care, and removal of aggravating causes as soon as possible played the critical role in the management of patients at crises. It could also be concluded that steroid therapy was an important therapeutic step during crisis in brittle myasthenics. The outcome of crises was 19% of fatality rate in crises(3 deaths among 16 cases) and 3% mortality rate in MG. There was no recurrence in 11 survivors and followup was lost in two other survivors.
Classification ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Mortality ; Myasthenia Gravis* ; Pathology ; Prognosis ; Recurrence ; Respiratory Insufficiency ; Risk Factors ; Seoul ; Survivors ; Thymoma ; Thymus Gland

BACKGROUND AND OBJECTIVES: The transradial approach for coronary intervention has a lower incidence of access site complications and can increase patient comfort after percutaneus tansluminal coronary angioplasty(PTCA). The purpose of this study is to compare procedural success and complication rates of percutaneous transradial coronary stenting which was performed by four operators in two hospitals with those using transfemoral approach. MATERIALS AND METHOD: From September 1998 to July 1999, one hundred seventy five consecutive patients(201 lesions) treated with coronary stent implantation were enrolled for this study : 84 patients underwent transradial coronary stenting(Radial Group), and 91 patients transfemoral coronary stenting(Femoral Group). RESULTS: Seven patients who failed coronary cannulation via radial artery were crossed over to the Femoral Group. The measurements of the radial artery were not done. Patient demographics were similar in both groups. Procedural success was similar in both group(95.2% in Radial Group vs. 97.8% in Femoral Group, p=S). All transradial coronary stenting were possible using conventional guiding catheters which are used in transfemoral intervention. Local vascular complication rates showed a trend toward a reduction in the Radial Group(2.4% vs. 8.8%, p=.06). CONCLUSION: This study showed the similarity in the safety and efficacy of transradial coronary stenting compared to those of transfemoral approach.
Catheterization ; Catheters ; Demography ; Humans ; Incidence ; Radial Artery ; Stents*

No abstract available.
Hysterectomy*

No abstract available.
Thyrotropin*

BACKGROUND: The clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. The use of high pressure balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. Therefore, we evaluated the effect of anticoagulation of subacute thrombosis sfter stenting retrospectively on a consecutive series of patients who received palmaz-Schatz coronary stents with high pressure balloon dilatation. METHOD: From March 1995 to August 1995, 62 patients underwent Palmaz-Schatz coronary stent implantation. After deploying stents successfully, high pressure overdilatation of the stents was performed in all patients. According to post-stent anticoagulation, 32 patients received aspirin 200 mg/day, ticlopidine 500 mg/day and warfarin for two months, 30 patients received aspirin and ticlopidine. RESULTS: The clinical or angiographic variables were not significantly different between the two groups. There was no acute or subacute thrombosis in the two groups. The hospital stay after stenting was significantly shorter in the patients without antcoagulation than in patients with anticoagulation. CONCLUSION: The Palmaz-Schatz stent can be safely implanted without anticoagulation provided that stent expansion is daequate by the use high pressure balloon dilatation This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.
Aspirin ; Dilatation* ; Humans ; Length of Stay ; Retrospective Studies ; Stents* ; Thrombosis ; Ticlopidine ; Ultrasonography ; Warfarin

OBJECTIVE: The natural course of unruptured vertebral artery dissection remains unclear. The clinical manifestation of unruptured vertebral artery dissection varies from headache, focal neurologic deficits caused by ischemia to subarachnoid hemorrhage with high mortality. The purpose of this study is to investigate the clinical course of unruptured vertebral artery dissection. METHODS: From March 2011 to April 2013, 7 patients with headache or nuchal pain by spontaneous vertebral artery dissection visited our institute were retrospectively reviewed. Their clinical data was obtained by medical records and radiologic studies including computed tomographic angiography, magnetic resonance imaging, magnetic resonance angiography and digital subtraction angiography. RESULTS: No patient experienced fatal outcome by subarachnoid hemorrhage or vertebrobasilar ischemia during follow-up period. Radiologic studies also did not show the evidence of subarachnoid hemorrhage or vertebrobasilar ischemia. Follow-up angiography showed the decreased size or disappearance of aneurysm in 3 patients. CONCLUSION: This study suggests that the natural course of unruptured vertebral artery dissection is not aggressive. Patients with unruptured vertebral artery dissection could be managed with conservative treatment including anticoagulants and/or antiplatelet agents.
Aneurysm ; Aneurysm, Dissecting ; Angiography ; Anticoagulants ; Fatal Outcome ; Follow-Up Studies ; Headache ; Humans ; Ischemia ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Medical Records ; Mortality ; Neurologic Manifestations ; Platelet Aggregation Inhibitors ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vertebral Artery Dissection* ; Vertebral Artery* ; Vertebrobasilar Insufficiency

Objective: : Anterior cervical spine surgery (ACSS) is a common surgical procedure used to treat cervical spinal degenerative diseases. One of the complications associated with ACSS is prevertebral soft tissue swelling (PSTS), which can result in airway obstruction, dysphagia, and other adverse outcomes. This study aims to investigate the correlation between various cervical sagittal parameters and PSTS following single-level ACSS, as well as to identify independent risk factors for PSTS. Methods: : A retrospective study conducted at a single institution. The study population included all patients who underwent single-level ACSS between January 2014 and December 2022. Patients with a history of cervical spine surgery or trauma were excluded from the study. The presence and severity of PSTS was assessed by reviewing pre- and postoperative imaging studies. The potential risk factors for PSTS that were examined include patient age, sex, body mass index, tobacco use, comorbidities, serum albumin levels, operative time, implant type, implanted level, and various cervical spine sagittal parameters. Multivariate linear regression analysis was performed to identify the independent risk factors for PSTS. Results: : A total of 62 consecutive patients who underwent single-level ACSS over a 8-year period at a single institution were enrolled in this study. Only preoperative segmental angle showed positive correlation with PSTS among various cervical spine sagittal parameters (r=0.36, p=0.005). Artificial disc replacement showed a negative correlation with PSTS (β=-0.38, p=0.002), whereas the use of demineralized bone matrix (DBM) had a positive impact on PSTS (β=0.33, p=0.009). We found that male sex, lower preoperative serum albumin, and implantation of upper cervical level (above C5) were independent predictors for PSTS after single-level ACSS (β=1.21; 95% confidence interval [CI], 0.27 to 2.15; p=0.012; β=-1.63; 95% CI, -2.91 to -0.34; p=0.014; β=1.44; 95% CI, 0.38 to 2.49; p=0.008, respectively). Conclusion : Our study identified male sex, lower preoperative serum albumin levels, and upper cervical level involvement as independent risk factors for PSTS after single-level ACSS. These findings can help clinicians monitor high-risk patients and take preventive measures to reduce complications. Further research with larger sample sizes and prospective designs is needed to validate these findings.

BACKGROUND: In elective intervention, the implantation of an intracoronary stent is an established treatment modality to reduce restenosis in comparison with balloon angioplasty. However, stenting was empirically thought to be contraindicated for acute myocardial infarction because of the propensity for thrombosis, althought the percutaneous transluminal coronary balloon angioplasty(PTCA) on infarct-related artery is associated with a high incidence of restenosis. To knowlege, there is no report comparing the longterm efficacy of coronary stenting with PTCA in patients with acute myocardial infarction. Accordingly, we investigated the effect of stent implantation on restenosis of infarct-related artery in acute myocardial infarction, comparing with conventional balloon angioplasty. METHOD: From January 1994 to December 1995, 97 patients (stenting in 45 patients : PTCA in 52 patients) underwent intracoronary stenting or PTCA on infarct-related artery successfully at 7-10 days after onset of infarction. The coronary stents were Palmaz-Schatz stent in 35 patients and Cordis stent in 10 patients. Follow-up coronary angiography was performed in all patients 6 months later after intervention. RESULTS: No death, emergency coronary artery bypass surgery or reinfarction occurred during hospitalization in 97 patients. In 45 patients with stent implantation, no stent thrombosisoccurred. The 6-months angiographic restenosis rate was 13 percent in patients assigne to stent implantation and 52 percent in patients assigned to PTCA(p<0.05). CONCLUSION: We conclude that the intracoronary stent implantation on infarct-related artery at 7-10 days after acute myocardial infarction is safe, feasible and significantly reduces the restenosis rate.
Angioplasty, Balloon ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Emergencies ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Infarction ; Myocardial Infarction* ; Stents* ; Thrombosis

The purpose of this study is to review the validity of quantitative indices on the Evaluation of Korean Medical Schools in 1996. The data required for the indices were obtained from the 1996's edition of the Directory of Korea Medical Education and compared to the results of the evaluation. Among the quantitative indices of the evaluation the number of professors and assistants of basic medical science was the most valuable index to differentiate the better group from lesser groups of medical schools in Korea.
Education, Medical ; Korea ; Schools, Medical*

PURPOSE: Fournier's gangrene is a rapidly progressive fulminant infection of the perineum and abdominal wall along with the scrotum in men and the vulva in women. If the effective surgical treatment is delayed, the patients result in fatal. Modern surgical series report a mortality of 8-67%. Objective: The aims of this study were to examine the outcomes of 20 consecutive patients with Fournier's gangrene caused by a perianal abscess and to identify the factors leading to improved survival in these patients. METHODS: The medical records of all patients who had been treated at Chosun University Hospital between January 1991 and December 1999 for Fournier's gangrene caused by a perianal abscess were retrospectively reviewed. RESULTS: Twenty patients were identified (mean age 47 years, range 20-66). The sexual ratio was 2.3:1 (male:female). The etiologies included perianal fistula (35%), unknown (35%), hemorrhoidectomy (10%), rectal cancer perforation (10%), and injection therapy (10%). Associated conditions included diabetes mellitus (50%), liver cirrhosis (10%), pulmonary tuberculosis (5%), intestinal tuberculosis (5%), ulcerative colitis (5%), Crohn's disease (5%) and iron deficiency anemia (5%). Escherichia coli and bacteroid fragilis were most commonly identified. All 20 patients initially received multiple incisions and debridement. At the time of first surgery, a diverting colostomy was required in 35% of the cases and a ileostomy in 5%. Over the past 10 years, the survival rate of patients with Fournier's gangrene caused from perianal abscess has been high (100%). CONCLUSION: The keys to a successful outcome included early diagnosis, prompt surgical intervention with radical debridement, prompt fluid resuscitation, rapid initiation of broad-spectrum antibiotics, and hemodynamic support in an intensive care setting.
Abdominal Wall ; Abscess* ; Anemia, Iron-Deficiency ; Anti-Bacterial Agents ; Critical Care ; Colitis, Ulcerative ; Colostomy ; Crohn Disease ; Debridement ; Diabetes Mellitus ; Early Diagnosis ; Escherichia coli ; Female ; Fistula ; Fournier Gangrene* ; Hemodynamics ; Hemorrhoidectomy ; Humans ; Ileostomy ; Liver Cirrhosis ; Male ; Medical Records ; Mortality ; Perineum ; Rectal Neoplasms ; Resuscitation ; Retrospective Studies ; Scrotum ; Survival Rate ; Tuberculosis ; Tuberculosis, Pulmonary ; Vulva