BACKGROUND: Most stroke-related deaths occur shortly after the onset of symptoms. Analysis of early deaths after stroke is important, since some deaths may be preventable. It also helps to improve the quality of stroke management. We investigated the early mortality and the causes of death in acute ischemic stroke patients. METHODS: We reviewed the medical records of six hundred fifty-one consecutive acute ischemic stroke patients who admitted to HLMC (Hallym University Medical Center) between January 1993 and December 1996. The 30-day mortality rate and the cause of death in each case were assessed. RESULTS: Fifty patients (mean age, 67.7 years, male : female=1 : 1.3) of total 651 patients (mean age, 65.4 years, male : female=1:0.78) died within 30 days (7.7%). Thirty-three (7%) patients of the 471 patients who had supratentorial lesion and sixteen (10.5%) of the 151 patients who had infratentorial lesion died within 30 days. The 30-day mortality rate according to each stroke subtype were 8.2% in large-artery atherosclerosis (n=21), 26.4% in cardioembolism (n=14), 1.2% in small-vessel occlusion (n=3), 33.3% in strokes with other determined etiology (n=1), 12.1% in strokes with undetermined etiology (n=11). Twenty-eight patients (56%) died due to direct stroke-related causes such as herniation, evolving stroke and massive hemorrhagic transformation. Twenty-two patients (44%) died from indirect stroke-complicated causes such as sepsis (n=7, 14%), heart disease (n=6, 12%), pneumonia (n=5, 10%), massive bleeding at tracheostomy site (n=1, 2%), pulmonary edema (n=1, 2%) and unknown cause (n=2, 4%). Forty patients (80%) died in the first 10 days and the main causes of death were herniation and evolving stroke. After the first 10 days, ten patients (20%) died of relative immobility (pneumonia, sepsis, pulmonary embolism). CONCLUSION: To reduce the early mortality within the first 10 days after the onset, aggressive control of IICP with the amelioration of brain edema must be emphasized. Whilst, to reduce the early mortality after the first 10 days, vigorous efforts to prevent and treat complications, such as pneumonia, pulmonary embolism and sepsis should be done.
Atherosclerosis ; Brain Edema ; Cause of Death* ; Cerebral Infarction ; Heart Diseases ; Hemorrhage ; Humans ; Male ; Medical Records ; Mortality* ; Pneumonia ; Pulmonary Edema ; Pulmonary Embolism ; Sepsis ; Stroke* ; Tracheostomy

BACKGROUND: As a complication of iron deficiency anemia, only a few cases of the infarction involving major cerebral artery territory area have been reported. Although the reactive thrombocytosis secondary to iron-deficiency anemia may be suggested as a cause, the exact mechanism is unclear. Until now, the sole possible level of thrombocytosis associated with iron deficiency anemia for cerebrovascular accident has been reported as more than 8.0 x 105/mm3. Case Description : We present a case of young woman with mild reactive thrombocytosis(5.95 x 105/mm3) secondary to iron deficiency anemia who developed left middle cerebral artery territorial infarction. We did not find any other precipitating factors despite of all possible etiological evaluations including cerebral angiography. After the treatment of iron supplement and antiplatelet agent, the recovery was relatively good and no definite neurological deficits were remained. CONCLUSION: We suggest that this large territorial infarction might be related to the severe iron deficiency anemia and the reactive thrombocytosis associated with iron deficiency anemia and the correction of anemia and antiplatelet therapy is a reasonable approach.
Anemia ; Anemia, Iron-Deficiency* ; Cerebral Angiography ; Cerebral Arteries ; Female ; Humans ; Infarction* ; Iron* ; Middle Cerebral Artery ; Precipitating Factors ; Stroke ; Thrombocytosis*

PURPOSE: PET-CT is often used to differentiate benign or malignant thyroid incidentalomas. In this retrospective study, we evaluated whether the ¹⁸F-FDG uptake pattern and PET-CT findings improved accuracy over the standardized uptake value (SUV). METHODS: ¹⁸F-FDG PET-CT was performed on 2,178 subjects from August, 2004, to October, 2007, in Sung-ae Hospital. PET-CT was performed on 806 patients (37%) with suspected or known nonthyroidal cancer and 1,372 healthy subjects (63%) without a previous history of cancer. We investigated the clinical characteristics of patients, history, standardized uptake value (SUV), ultrasonography, and hormone levels in blood. Thyroidal cancer was confirmed by ultrasonography-guided fine needle aspiration and pathology after thyroid operation. RESULTS: The prevalence of focal thyroid lesions on PET-CT was 8.8% (191/2178). Thyroid cancer confirmation was 7.9% (15/191). The maximum SUV of malignant thyroid lesions were significantly higher than that of benign lesions (7.00±3.08 vs. 4.49±1.84, P<0.001). CONCLUSION: PET-CT image interpretation that includes 18F-FDG uptake and SUV is better than PET-CT alone for differentiating benign and malignant lesions. Thyroid cancer risk increases as SUVmax levels increase.
Biopsy, Fine-Needle ; Fluorodeoxyglucose F18 ; Healthy Volunteers ; Humans ; Pathology ; Prevalence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography

Purpose: EGFR-mutation (EGFR-mt) is a major oncogenic driver mutation in lung adenocarcinoma (ADC) and is more oftenobserved in Asian population. In lung ADC, some radiomics parameters of FDG PET have been reported to be associated withEGFR-mt. Here, the associations between EGFR-mt and PET parameters, particularly asphericity (ASP), were evaluated inAsian population. Methods: Lung ADC patients who underwent curative surgical resection as the first treatment were retrospectively enrolled.EGFR mutation was defined as exon 19 deletion and exon 21 point mutation and was evaluated using surgical specimens. OnFDG PET, image parameters of maximal standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesionglycolysis (TLG), and ASP were obtained. The parameters were compared between EGFR-mt and wild type (EGFR-wt) groups,and the relationships between these PET parameters and EGFR-mt were evaluated. Results: A total of 64 patients (median age 66 years, M:F = 34:30) were included in the analysis, and 29 (45%) patients showedEGFR-mt. In EGFR-mt group, all the image parameters of SUVmax, MTV, TLG, and ASP were significantly lower than inEGFR-wt group (all adjusted P< 0.050). In univariable logistic regression, SUVmax (P= 0.003) and ASP (P= 0.010) weresignificant determinants for EGFR-mt, whereasMTV was not (P= 0.690). Multivariate analysis revealed that SUVmax and ASPare independent determinants for EGFR-mt, regardless of inclusion of MTV in the analysis (P< 0.05). Conclusion In Asian NSCLC/ADC patients, SUVmax, MTV, and ASP on FDG PET are significantly related to EGFR mutationstatus. Particularly, low SUVmax and ASP are independent determinants for EGFR-mt.

Purpose: The precise quantification of dopamine transporter (DAT) density on N-(3-[18F]Fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl) nortropane positron emission tomography ([18F]FP-CIT PET) imaging is crucial to measure the degree of striatal DAT loss in patients with parkinsonism. The quantitative analysis requires a spatial normalization process based on a template brain. Since the spatial normalization method based on a delayed-phase PET has limited performance, we suggest an early-phase PET-based method and compared its accuracy, referring to the MRI-based approach as a gold standard. Methods: A total of 39 referred patients from the movement disorder clinic who underwent dual-phase [18F]FP-CIT PET and took MRI within 1 year were retrospectively analyzed. The three spatial normalization methods were applied for quantification of [18F]FP-CIT PET-MRI-based anatomical normalization, PET template-based method based on delayed PET, and that based on early PET. The striatal binding ratios (BRs) were compared, and voxelwise paired t tests were implemented between different methods. Results: The early image-based normalization showed concordant patterns of putaminal [18F]FP-CIT binding with an MRI-based method. The BRs of the putamen from the MRI-based approach showed higher agreement with early image- than delayed image-based method as presented by Bland-Altman plots and intraclass correlation coefficients (early image-based, 0.980; delayed image-based, 0.895). The voxelwise test exhibited a smaller volume of significantly different counts in putamen between brains processed by early image and MRI compared to that between delayed image and MRI. Conclusion The early-phase [18F]FP-CIT PET can be utilized for spatial normalization of delayed PET image when the MRI image is unavailable and presents better performance than the delayed template-based method in quantitation of putaminal binding ratio.

BACKGROUND: The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. METHODS: PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test(FEV1, FEV1%pred, FVC, and FVC%pred) were measured at first visiting. RESULTS: Values of PIFn, FEV1, and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was 41.4+/-15.9 years. Normal subjects were 32 (22 males and 10 females) and the mean age was 39.8+/-18.6 years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p<0.05). The PIFn values in patients with chronic cough was significantly lower than those of normal subjects(2.25+/-0.68 L/sec vs. 2.75+/-1.00 L/sec; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects(meanD; 2.18+/-0.66 vs. 2.75+/-1.00 L/sec, p=0.006). CONCLUSION: There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.
Adult ; Cough* ; Humans ; Male ; Masks ; Nasal Obstruction ; Nose ; Respiratory Function Tests ; Respiratory System ; Spirometry

Purpose: To evaluate the safety, efficiency, and size-dependency of the ‘Inverted omega En-bloc (Ʊ)’ holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms. Materials and Methods: A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014–2021. These patients were treated using the ‘Inverted omega En-bloc’ HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40–60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed. Results: The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer. Conclusions The inverted omega En-bloc HoLEP technique is safe and effective for the treatment of BPH. Moreover, ‘Inverted omega En-bloc’ HoLEP is a size-independent and effective method for all prostate sizes.

PURPOSE: To evaluate the efficacy of unenhanced MR imaging compared to the diagnostic accuracy, advantage, and limitations of abdominal ultrasonography in the diagnosis of acute appendicitis. MATERIALS AND METHODS: The study included 40 patients suspected of having acute appendicitis and who were subjected to an unenhanced MR image, as well as an abdominal ultrasonography. A T1 FLASH in an axial image, a chemical shift-selective fat suppressed T2 HASTE in an axial image, as well as a T2 HASTE in an axial and coronal image were obtained as unenhanced MR images. The diagnosis was established based on a surgical or clinical follow-up of the unenhanced MR results, which were then statistically compared to the ultrasonographic results. RESULTS: The surgical or clinical follow-up results revealed that 25 patients were positively diagnosed with appendicitis. Of these, 7 patients had symptoms of acute appendicitis with no pathologic diagnoses, whereas the 8 remaining patients were diagnosed with another condition. The sensitivity and accuracy of the unenhanced MR imaging was 92% and 90%, compared to ultrasonography which was 68% and 72.5% accurate, respectively. The differences in sensitivity and accuracy between the two methods were found to be statistically significant (p < .05, chi-square test). Based on these results, unenhanced MR imaging was superior to sonography for the diagnosis of appendicitis. CONCLUSION: Unenhanced MR imaging may be a useful modality for the diagnosis of acute appendicitis, especially for suboptimal or nondiagnostic sonographies, as well as patients that are particularly sensitive to radiation exposure.
Acute Disease ; Appendicitis ; Appendix ; Follow-Up Studies ; Humans ; Imidazoles ; Nitro Compounds