STUDY DESIGN: Retrospective study. PURPOSE: To determine the prevalence of high risk patient with osteopenia requiring pharmacologic treatment and investigate the difference of 10-year fracture probability whether bone mineral density (BMD) include or not in Korean FRAX model. OVERVIEW OF LITERATURE: Many people with the fracture have osteopenia rather than osteoporosis, and BMD alone could be considered as a chance to prevent fracture. METHODS: Three hundred sixty-nine patients who was diagnosed as osteopenia were divided into two groups according to age (group 1, under 65 years; group 2, over 65 years), and 10-year fracture probabilities were calculated by FRAX algorithm with and without femur neck T-score. RESULTS: The high risk patients of the fracture who had above 3% of 10-year hip fracture probability were 15 cases in group 1 and 121 cases in group 2. In 193 patients of group 1, the mean 10-year fracture probability with BMD was significantly higher than the results without BMD (hip fracture: p=0.04, major osteoporotic fracture: p=0.01). Unlike the results of the group 1, the mean 10-year fracture probability without BMD was significantly higher than the results with BMD in 176 patients of group 2 (hip fracture: p=0.01, major osteoporotic fracture: p=0.01). CONCLUSIONS: Total of 136 cases (36.8%) as a high risk of the fracture with osteopenia could be overlooked treatment eligibility in Korean. The Korean FRAX model without BMD could be effective in predicting fracture risk especially in the individuals who were over 65 years.
Bone Density ; Bone Diseases, Metabolic* ; Femur Neck ; Hip ; Humans ; Osteoporosis ; Osteoporotic Fractures ; Prevalence ; Retrospective Studies ; Risk Assessment

No abstract available.
Etoposide* ; Fluorouracil* ; Stomach Neoplasms*

PURPOSE: Endoscopic bile duct decompression using bilateral self-expandable metallic stents (SEMSs) deployed via a stent-in-stent (SIS) method is considered a preferred procedure for malignant hilar biliary obstruction (MHBO). However, occlusion thereof occurs frequently. Here, we investigated stent patency duration and risk factors related to stent obstruction with bilateral SIS placement for MHBO at two large centers. MATERIALS AND METHODS: The present study reviewed data on patients with MHBO who underwent endoscopic biliary drainage using the SIS method. Clinical outcomes, including stent patency duration and patient overall survival, were analyzed. Factors associated with stent patency were evaluated using Cox proportional hazards models. RESULTS: Seventy patients with MHBO underwent endoscopic biliary drainage using the SIS method. Median age was 68 years old, and median follow-up duration was 140 days (interquartile range, 57–329). The proportion of high-grade MHBOs (Bismuth type IV) was 57.1%. Median stent patency duration with the SIS method was 108 days according to Kaplan-Meier curves. Median patient survival analyzed by the Kaplan-Meier method was 181 days. Multivariate analysis indicated that higher baseline bilirubin (> 6.1 mg/dL) as an independent risk factor related to stent patency (p < 0.05). CONCLUSION: In endoscopic biliary decompression using SEMS placed with the SIS method, obstructive jaundice was a risk factor for stent patency. The SIS method for high-grade MHBO showed short stent patency.
Bile Ducts ; Bilirubin ; Decompression ; Drainage ; Follow-Up Studies ; Humans ; Jaundice, Obstructive ; Methods ; Multivariate Analysis ; Proportional Hazards Models ; Risk Factors ; Stents*

No abstract available.
Quetiapine Fumarate ; Stroke

Centric occlusion-maximum intercuspation (CO-MI) discrepancy is one of main causes of evoking premature contact and resultant mandibular shift. These non-physiological conditions can induce temporomandibular disease, periodontitis, and non-carious cervical lesion. Therefore, if CO-MI discrepancy exists in patients who need extensive prosthetic rehabilitation, it must be corrected and then physiological occlusion must be restored. This report describes the treatment procedure of removing CO-MI discrepancy and prosthetic rehabilitation in a patient with 3.5 mm discrepancy, multiple caries and periodontitis. Proper mandibular position and modified opening & closing movement were confirmed by ARCUSdigma II and transcranial radiograph.
Centric Relation ; Humans ; Periodontitis ; Rehabilitation*

BACKGROUND: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, but hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients. METHODS: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from the prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36 hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from 0 (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics. RESULTS: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute of Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke-Monitoring Study definitions), unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3 months, and mortality at 3 months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively; p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001). CONCLUSIONS: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and the long-term clinical outcome.
Atrial Fibrillation ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Logistic Models ; Magnetic Resonance Imaging ; National Institute of Neurological Disorders and Stroke ; Neuroimaging ; Prospective Studies ; Retrospective Studies ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator

BACKGROUND: The role of uric acid in cerebrovascular disease is controversial. Uric acid may be an independent risk factor for cerebrovascular diseases but its neuroprotective role as an antioxidant has also been suggested. We studied the effects of uric acid on the early prognosis in acute ischemic stroke. METHODS: The subjects were 721 patients with moderate-to-severe acute stroke who arrived at hospital within 48 hours from the onset of symptoms. Patients were divided into quartiles based on serum uric acid levels at admission. In-hospital stroke outcome were calculated on the National Institutes of Health Stroke Scale (NIHSS) and analyzed by multivariate logistic regression. RESULTS: Differences in NIHSS scores between baseline and discharge in the patients were not significantly related to serum uric acid levels. However, in large artery atherosclerosis group, the proportion of patients with neurological improvement and differences in NIHSS score between baseline and discharge differed between the quartile uric acid groups (p<0.01 and p=0.04, respectively). A multivariate analysis adjusting for known vascular risk factors showed that a higher uric acid level was associated with a higher probability of a good in-hospital outcome (odds ratio, 1.31 per additional 1 mg/dL; 95% confidence interval, 1.07-1.60 per additional 1 mg/dL), but only in those with large-artery atherosclerosis. CONCLUSIONS: Uric acid level is independently correlated with the neurological improvement in patients with acute ischemic stroke caused by large-artery atherosclerosis.
Arteries ; Atherosclerosis ; Humans ; Hyperuricemia ; Logistic Models ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Prognosis ; Risk Factors ; Stroke ; Uric Acid

BACKGROUND: Treatment with heparin has been an area of great controversy among neurologists. The goal of this study was to compare the actual usage patterns of intravenous heparin according to the stroke subtype, location, severity of the stroke, different hospitals, and various departments. METHODS: The records of 1204 patients with acute ischemic stroke admitted to 10 teaching hospitals between January 2000 and December 2000 were reviewed. The patients were divided into two groups of whether or not they were given intravenous heparin. Cases of acute ischemic stroke were subdivided according to the TOAST classification. Patients with NIH Stroke Scale scores were categorized as having mild, moderate, and severe stroke. Terminal hospital stays were subdivided further by department: internal medicine, neurology, neurosurgery, rehabilitation medicine, and others. RESULTS: 512 patients (42.5%) were treated with heparin. The usage of heparin in the case of large artery atherosclerosis occupied 46%, small vessel occlusion 31 percent, cardioembolism 73%, other determined etiology 33%, and undetermined etiology 46%. Heparin was used to treat 46% of the patients with a lesion of anterior circulation, 49% of posterior circulation, and 38% of both anterior and posterior circulation. Heparin was more frequently used for moderate and severe strokes compared to mild strokes. CONCLUSIONS: The utilization of intravenous heparin was more frequent in treatment of the cardioembolism subtype and moderate-to-severe strokes. Practice variation according to the hospitals and discharge departments were manifested.
Arteries ; Atherosclerosis ; Cerebral Infarction ; Classification ; Heparin* ; Hospitals, Teaching* ; Humans ; Internal Medicine ; Length of Stay ; Neurology ; Neurosurgery ; Rehabilitation ; Stroke*

Extramedullary plasmacytomas are uncommon malignant neoplasms that can occur in any organ. They arise most frequently from the upper aerodigestive tract. Lymph nodes are exceedingly rare sites of extramedullary plasmacytomas. Most extramedullary plasmacytomas of the lymph node arise in the cervical lymph nodes. Here, we report a case of an extramedullary plasmacytoma of the lymph node arising from a cervical lymph node. A 43-year-old male patient was admitted to our hospital and presented with a non-tender mass on the left side of his neck, which had been growing slowly for 1 month. The mass was excised. The pathology showed diffuse infiltration of immature plasma cells that were encapsulated by a layer of lymphoid cells, indicating an extramedullary plasmacytoma. He was treated with local radiation of the left cervical area. As of March 2009, he is doing well and shows no further evidence of the disease.
Humans ; Lymph Nodes ; Lymphocytes ; Male ; Neck ; Plasma Cells ; Plasmacytoma