Background & Objective: The number of ischemic stroke is increasing steadily. The recent stroke prevention strategies have targeted risk factors for preventing ischemic stroke. Community-based data that quantify the prevalence of these risk factors are needed to develop effective stroke prevention strategies. This study was performed aiming to establish customized prevention strategies by investigating vascular risk factors of ischemic stroke among the healthy adults in an urban population in Korea. Methods: The Prevention of Stroke and Dementia (PRESENT) survey collected data associated with stroke risk factors between 2007 and 2009 in Ansan city, Korea. Of 46,537 people, 2,843 were selected by random sampling, and final population included 358 men and 422 women over 50 years old. We checked modifiable risk factors, such as hypertension, diabetes mellitus, smoking, hyperlipidemia, atrial fibrillation, cardiovascular disease, obesity, and physical inactivity. Results: The mean age of study subjects was 60.1±8.2 years; 55.5% had hypertension, 18.6% had diabetes mellitus, 17.7% were current smoker, 44.9% had hyperlipidemia, 1.7% had atrial fibrillation, and 4.5% had cardiovascular disease. Men had more risk factors for stroke, and higher rates of diabetes mellitus and current smoking. However, women had higher cholesterol and obesity rates and lower physical activity. The proportion of individuals with >1 risk factor for stroke increased with age. Hypertension, diabetes mellitus, and cardiovascular diseases also increased with age, but low-density lipoprotein levels and current smoking decreased. Conclusions: This study provides valuable information to develop customized strategic policies for primary and secondary stroke prevention.
Stroke

The most frequently reported neurological complication of a wasp sting is ischemic stroke. We treated a patient with wasp sting with unusual complications. A 52-year-old man was hospitalized for anaphylactic shock after multiple wasp stings. Although the patient recovered consciousness after 2 days, he had global aphasia and right hemiparesis. Brain magnetic resonance imaging and angiography revealed high-intensity signals in the left basal ganglia and cerebral cortex and stenosis of the left middle cerebral artery. After 2 days, the middle cerebral artery stenosis improved. After 5 days, diffusion-weighted imaging showed an enlarged lesion in the left frontal cortex. The infarct in this case was due to a predominantly unilateral vasoconstrictive hypoxic brain injury from wasp stings.
Brain Injuries

No abstract available.
Aortic Aneurysm, Abdominal* ; Ureter* ; Ureteral Obstruction*

PURPOSE: We evaluated the effectiveness of embolization in the management of congenital vascular malformations(CVMs). METHODS AND MATERIALS: A retrospective analysis was performed in 10 patients who underwent embolotherapy for their soft tissue CVMs(eight arteriovenous malformations, one hemangioma, one venous malformation) involving the extremity or back. In nine patients, intraarterial embolization was performed with multiple embolic agents including Gelfoam, Ivalon, IBCA, ethanol mixed with Lipiodol, and micro-coils. In one patient with venous malformation, direct puncture and embolization of the lesion were performed with absolute ethanol mixed with Lipiodol. RESULTS: In four patients, who subsequently underwent surgery, preoperative embolization decreased operative morbidity and facilitated a thorough extirpation. Five of six patients with inoperable CVMs experienced dramatic reduction of symptoms by single or repeated embolization, with a mean follow-up period of four months. CONCLUSION: We believe that preoperative embolization may decrease operative morbidity and facilitate a thorough extirpation in the patients with extensive but resectable CVMs and repeated embolizations are effective for symptom control in the patients with inoperable CVMs.
Arteriovenous Malformations ; Embolization, Therapeutic ; Ethanol ; Ethiodized Oil ; Extremities* ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemangioma ; Humans ; Punctures ; Retrospective Studies ; Vascular Malformations*

No abstract available.
Burns* ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: Although its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors. METHODS: The medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups. RESULTS: Of the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001). CONCLUSION: Postoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications.
Age Distribution ; Anesthesia ; Body Mass Index ; Cystectomy ; Humans ; Ileus ; Incidence ; Laparoscopy ; Linear Models ; Medical Records ; Postoperative Complications ; Risk Factors ; Urology

PURPOSE: To determine whether liver stiffness (LS) measured by magnetic resonance elastography (MRE) can predict the outcome of radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODS: A total of 107 patients with Child-Pugh class A liver function who were treated with RFA for single HCC and who had undergone a gradient-echo MRE within 6 months before RFA were included. We evaluated the relationship between the LS values and the ablation volume, local tumor progression (LTP), and intrahepatic distant recurrence (IDR). We also constructed receiver operating characteristic (ROC) curves to examine the role of LS in predicting liver function deterioration, which was defined as an increase of Child-Pugh score by one point or more at 1 year after RFA. RESULTS: There was no significant correlation between LS and ablation volume, and neither time to LTP nor IDR was associated with LS. Among the 66 patients who did not have recurrence 1 year after RFA, 5 patients (7.6%) developed liver function deterioration. A high LS value was significantly associated with development of liver function deterioration after RFA and the area under the ROC curve was 0.764 (95% CI 0.598-0.929, P = 0.003). CONCLUSION: LS measured by MRE could not predict ablation volume and tumor recurrence. However, high LS values were significantly associated with development of liver function deterioration.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Elasticity Imaging Techniques ; Humans ; Liver* ; Recurrence ; ROC Curve

Nowadays in the field of plastic surgery, operations with no general anesthesia have been much increased, using daily surgery center. We used "Propofol TCI system" to control exact target concentration of conscious sedation and to reduce any systemic complication of the other local anesthetics. Twenty of ASA Class I or II patients were scheduled for elective surgery using Diprifusor(R) TCI system at 0.8-1.9 ug/ml target concentration. We estimated the proper target concentration, time of awakening, postoperative patient satisfaction and presence of postoperative amnesia. All the patients was satisfied except one patients who underwent nasal tip plasty. The target concentration of the conscious sedation varies with age and the type of operation but average concentration was 1.4-1.6 ug/ml. The average time of awakening, which we estimated by the time of eye opening was 2.6 minutes. Postoperative systemic complication and unusual vital sign were not present. We present here our satisfactory results using propofol infused by TCI(Target controlled infusion) system. This system is called 'Diprifusor(R)' and has a benefit of excellent sedative effect, low complication rate, safety, and rapid awakening time which enables the patient to return to his normal life cycle.
Amnesia ; Anesthesia, General ; Anesthesia, Intravenous* ; Anesthesia, Local* ; Anesthetics, Local ; Conscious Sedation ; Humans ; Hypnotics and Sedatives ; Life Cycle Stages ; Patient Satisfaction ; Propofol* ; Surgery, Plastic* ; Vital Signs

PURPOSE:To investigate the changes of abnormal signal intensity of liver infarction in scheduled intervals after ligation of portal vein in rabbit livers with histopathologic correlation. MATERIALS AND METHODS:Liver infarction were induced by selective ligation of the posterior branch of right portal vein in 12 rabbits. T1- and T2-weighted MRI at 2.0T with spin-echo techniques as well as contrastenhanced Tl-weighted MRI with Gd-DTPA(0.1 mmol/kg) were performed 3 hours, 6 hours, 1 day, 3 days, 1 week, and 2 weeks after ligation using two rabbits at each interval. Histopathologic specimens were prepared from six removed livers for comparing the MR findings with the histopathologic findings. The other six rabbits were sectioned transversely in frozen state for comparing MR findings with the macroscopic findings of pathologic areas of the liver. RESULTS: The signal intensity of pathologic hepatic segment showed more hyperintense signal than that of normal segments of the liver on TI-, proton density-, and T2-weighted MR images at every interval after ligation, except both T2WI of 3 hours interval and one T1WI of 2 weeks interval. Main histopathologic findings 3 hours, 6 hours, 1 day, 3 days, and 1 week after ligation were congestion, hemorrhage with necrosis, coagulation necrosis, complete necrosis, and necrosis with scar tissues, respectively. Microscopic specimens with Prussian blue stain 6 hours, and 1 week after ligation showed bluish hue indicating the existence of methemoglobin, and blue particles in giant cells and monocytes indicating engulfing hemosiderin, respectively. CONCLUSION: Changes of the signal intensities on sequential MR images of acutely induced hemorrhagic liver infarction might be due to the rapid oxidative denaturation of hemoglobin in hemorrhages and high signal intensity on Tl-weighted images from the hyperacute stage of a hemorrhagic liver infarction could be due to methemoglobin. Therefore, acutely induced hemorrhagic liver infarction should be included in the differential diagnoses of the hyperintense liver lesions on Tl-weighted images.
Cicatrix ; Diagnosis, Differential ; Estrogens, Conjugated (USP) ; Giant Cells ; Hemorrhage ; Hemosiderin ; Infarction ; Ligation* ; Liver* ; Magnetic Resonance Imaging* ; Methemoglobin ; Monocytes ; Necrosis ; Portal Vein* ; Protons ; Rabbits*

OBJECTIVE: To determine whether saline-enhanced dual probe bipolar radiofrequency ablation (RFA) using perfused-cooled electrodes shows better in-vitro efficiency than monopolar or single probe bipolar RFA in creating larger coagulation necrosis. MATERIALS AND METHODS: RF was applied to excised bovine livers in both bipolar and monopolar modes using a 200W generator (CC-3; Radionics) and the perfused-cooled electrodes for 10 mins. After placing single or double perfused-cooled electrodes in the explanted liver, 30 ablation zones were created at three different regimens: group A; saline-enhanced monopolar RFA, group B; saline-enhanced single probe bipolar RFA, and group C; saline-enhanced dual probe bipolar RFA. During RFA, we measured the tissue temperature at 15 mm from the electrode. The dimensions of the ablation zones and changes in the impedance currents and liver temperature during RFA were then compared between the groups. RESULTS: The mean current values were higher for monopolar mode (group A) than for the bipolar modes (groups B and C) : 1550+/-25 mA in group A, 764+/-189 mA in group B and 819+/-98 mA in group C (p < 0.05). The volume of RF-induced coagulation necrosis was greater in group C than in the other groups: 27.6+/-2.9 cm3 in group A, 23.7+/-3.8 cm3 in group B, and 34.2+/-5.1 cm3 in group C (p < 0.05). However, there was no significant difference between the short-axis diameter of the coagulation necrosis in the three groups: 3.1+/-0.8 cm, 2.9+/-1.2 cm and 4.0+/-1.3 cm in groups A, B and C, respectively (p > 0.05). The temperature at 15 mm from the electrode was higher in group C than in the other groups: 70+/-18 degrees C in group A, 59+/-23 degrees C in group B and 96+/-16 degrees C in group C (p < 0.05). CONCLUSION: Saline-enhanced bipolar RFA using dual perfused-cooled electrodes increases the dimension of the ablation zone more efficiently than monopolar RFA or single probe bipolar RFA.
Animals ; Catheter Ablation/*instrumentation ; Cattle ; Comparative Study ; Electrocoagulation ; In Vitro ; Liver/pathology/*surgery ; Necrosis ; Sodium Chloride ; Support, Non-U.S. Gov't