BACKGROUND: It has been reported that organized inpatient (stroke unit) care reduces the mortality rate, and the need for institutional care or dependent living after stroke. Based on this evidence, stroke units have becomes popular among large-scale hospitals in developed countries. The aim of this study was to provide perspective regarding the efficacy of stroke units and their current status in developed countries. Methods and RESULTS: An electronic search was conducted using the Cochrane Database, PubMed, and other online databases, in addition to a manual search. The efficacy of stroke-unit care compared to general-ward care was summarized and is presented with respect to death, death or institutional care, and death or dependency by the end of the scheduled follow-up. Current concepts and the status of stroke-unit services among developed countries were reviewed and compared with each other. The desirable models of stroke-unit services are discussed in terms of the stroke center. CONCLUSIONS: Stroke is the second leading cause of death in Korea and there that stroke-unit care is effective at improving the outcome of stroke patients. The expeditious development and realization of organized inpatient care for stroke victims should be a Government priority.
Cause of Death ; Dependency (Psychology) ; Developed Countries ; Electronics ; Electrons ; Follow-Up Studies ; Humans ; Inpatients ; Korea ; Stroke

A previously healthy 44-year-old male was admitted with the chief complaint of intermittent gross hematuria. On initial ultrasonographic and CT examination, a grossly protruding intravesical tumor was noted and, under the impression of a malignant bladder tumor, transurethral resection was performed. The histological findings were spindle cells with elongated cytoplasm with rare mitotic figures distributed in myxoid stroma, consistent with diagnosis of inflammatory pseudotumor of the bladder. The benign nature of this tumor warrants conservative surgical management, usually consisting of transurethral resection or partial cystectomy. No reports of metastasis have been reported following complete excision. Therefore, any suspicion and recognition of this entity is imperative to avoid performing an irreversible radical procedure.
Adult ; Bladder Diseases/surgery ; Bladder Diseases/pathology* ; Case Report ; Granuloma, Plasma Cell/surgery ; Granuloma, Plasma Cell/pathology* ; Human ; Male

To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Ear ; New Zealand ; Survival Rate ; Veins

Heat and moisture exchanger filters (HMEF), used for humidification of patient respiratory gas and filtering microorganisms can cause airway obstruction. We experienced serious airway obstruction in a HMEF after making hydrothorax for high intensity focused ultrasound (HIFU) procedure. The airway obstruction was difficult to differentiate from severe bronchospasm irresponsive to bronchodilator therapy. It was relieved dramatically after we removed the filter from the breathing circuit as soon as we detected air-fluid meniscus in it.
Airway Obstruction ; Bronchial Spasm ; Hot Temperature ; Humans ; Hydrothorax ; Respiration

To characterize the association between chronic kidney disease (CKD), mortality, severity of coronary artery disease (CAD), treatment modality of CAD, and type of coronary stents among patients undergoing coronary angiography (CAG), we retrospectively reviewed the electronic medical records of the patients who underwent CAG at Seoul National University Bundang Hospital in Korea between May 2003 and January 2006. CKD was staged using an estimated glomerular filtration rate (eGFR) from the creatinine value prior to CAG. There were 3,637 patients included. The presence of CAD was 48% in CKD stage 1, 61% in stage 2, 73% in stage 3, 87% in stage 4, and 81% in stage 5. Survival rate gradually diminished for patients with decreasing renal function. No significant differences in all-cause and cardiac mortality were observed by medical treatment, PCI or CABG, in CKD patients with an eGFR less than 60 mL/min/1.73 m(2). CKD patients with drug-eluting stents showed significantly lower all-cause mortality (5.4% vs. 13.3%) and incidence of myocardial infarction (1.7% vs. 10%) than those with bare metal stents. In conclusion, an eGFR is a strong independent prognostic marker among patients undergoing CAG and the severity of CAD increases progressively with worsening renal function.
Aged ; Coronary Angiography/*methods ; Coronary Artery Disease/complications/*diagnosis/mortality ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension ; Kidney/pathology/*physiology ; Kidney Diseases/complications/*diagnosis/mortality ; Kidney Function Tests ; Male ; Middle Aged ; Stents ; Time Factors ; Treatment Outcome

Periodic paralysis associated with thyrotoxicosis is characterized by intermittent flaccid paralysis of the skeletal muscle. The paralysis usually involve the skeletal muscle of the limbs, especially lower extrimities. In general, sensory function is intact. Involvement of respiratory, ocular or bulbar muscles is very rare, but bulbar and respiratoy invelvement may prove fatal. It is very rare a case that has severe clinical manifestation such as cardiac arrest. We report a case of thyrotoxic hypokalemic periodic paralysis presenting as cardiac arrest.
Extremities ; Heart Arrest ; Hypokalemic Periodic Paralysis ; Muscle, Skeletal ; Muscles ; Paralysis ; Sensation ; Thyrotoxicosis

The Q-switched lasers which was introduced under the concept of selective photothermolysis. Q-switched Nd:YAG laser, which targets dark pigments in a longer wave length (1064 nm) that has less absorption by melanin, can effectively treat deep tattoos with less pigmentary alterations. We report our experience over the past 3 years in treating 565 patients with tattoos and cutaneous pigmented lesions using the Q-switched Nd:YAG laser. Patients were exposed with a pulse duration of 10 ns and fluences of 6, 7 J/cm2(1064 nm) or 12, 14 J/cm2(532 nm), in exposure spots of 2 mm or 3 mm, at intervals of 4 weeks. Q-switched Nd:YAG laser was effective in removing deep pigmented lesion with 1064 nm, and colored inks with 532 nm. Seventy-three percent of amateur black pigmented lesion were > 75% clear after four to ten treatment. Ninty-eight percent of professional black pigmented lesion were > 75% clear after two on eyebrow, six to eight on extremity and trunk. No significant side effects, including pigmentary changes or scarring, were noted.
Absorption ; Cicatrix ; Extremities ; Eyebrows ; Humans ; Ink ; Melanins

Subdural injection of epidural anesthesia is rare and is usually undiagnosed during epidural anesthesia causing severely delayed maternal hypotension, hypoxia, and fetal distress. A 38-year-old primiparous woman was administered epidural labor analgesia at 40(+6) weeks' gestation, and developed progressive maternal respiratory depression, bradycardia, and hypotension after accidental subdural administration of the anesthetic agent. Furthermore, fetal distress occurred soon after administration. The patient was managed with oxygen, position changes, fluid resuscitation, and ephedrine. Intrauterine fetal resuscitation was successfully performed with atropine before cesarean section, and a healthy baby was delivered. Although subdural injection is uncommon, this case emphasizes the importance of anesthesiologists monitoring patients for a sufficient period after epidural labor analgesia, and being prepared to perform maternal or fetal resuscitation.
Analgesia ; Analgesia, Epidural ; Anesthesia, Epidural ; Anoxia ; Atropine ; Bradycardia ; Cesarean Section ; Ephedrine ; Female ; Fetal Distress ; Humans ; Hypotension ; Oxygen ; Pregnancy ; Respiratory Insufficiency ; Resuscitation ; Subdural Space

PURPOSE: To identify the necessity of more reasonable diagnostic criteria and the possibility of early prediction of coronary involvement in the higher risk group, we investigated and compared clinical and laboratory findings in the acute phase and coronary involvements in those younger (n=17) and older(n=53) than one year of age in Kawasaki disease(KD). METHODS: Retrospective chart reviews were performed on 70 patients with KD who were admitted to the Chung-Ang University Hospital from April 1997 to May 2001. RESULTS: Male were significantly higher in the younger age group(M : F ratio 3.3 : 1 vs. 1.0 : 1, P=0.004). Fever durations before intravenous immunoglobulin(IVIG) and echocardiography were significantly shorter in the younger group(4.6+/-1.3 vs. 6.2+/-2.5, P=0.004 vs. 0.01, respectively). Cases meeting typical diagnostic criteria were significantly less in the younger group(P=0.006). In the laboratory findings, serum albumin, BUN and K+ levels in the acute febrile phase were significantly higher in the younger group(P=0.002, 0.006, <0.001, respectively) and incidences of coronary artery dilatation in the acute phase were significantly higher in the younger group(P=0.01). CONCLUSION: Although less met the typical diagnostic criteria of KD, infants younger than one year of age are more susceptible to coronary artery change in the acute febrile phase. Therefore, KD should be entertained as a diagnostic possibility in young infants with prolonged fever without distinct fever focus, and echocardiography should be considered as part of the evaluation of these patients, and then early diagnosis and prompt IVIG should be conducted.
Coronary Vessels ; Dilatation ; Early Diagnosis ; Echocardiography ; Fever ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Serum Albumin

PURPOSE: The purpose of this study is to evaluate the efficacy of the trochanter reattachment device (TRD) as a firm internal fixation method for bipolar hemiarthroplasty in unstable intertrochanteric femur fracture for elderly patients over 65 years old. MATERIALS AND METHODS: From September 2010 to April 2011, 19 patients (M/F: 1/18) over 65 years old were treated with bipolar hemiarthroplasty using the TRD as a fixation method for intertrochanteric femur fracture with above Evans-Jensen classification 2nd (above AO/OTA A1.3). They were followed up for more than 12 months(12-29 months). RESULTS: Out of 19 patients, only one had loosening of the TRD plate and reoperation was performed. There was no dislocation after surgery. Complete fracture union was observed in 19 patients with follow up of more than 12 months. CONCLUSION: In bipolar hemiarthroplasty for intertrochanteric femur fracture, TRD produced easy and firm fixation. Additional fixation with TRD restoring abduction force by union of greater trochanter can be a good choice of surgery for avoidance of dislocation and chronic pain due to trochanteric nonunion after arthroplasty.
Aged* ; Arthroplasty* ; Chronic Pain ; Classification ; Dislocations ; Femur* ; Follow-Up Studies ; Hemiarthroplasty ; Hip Dislocation ; Humans ; Methods ; Reoperation