In stroke patients, upper extremity deep vein thrombosis (UEDVT) is uncommon compared with lower extremity. Unlike the blood stasis in lower extremity, UEDVT has been developed by secondary cause. We reported a case of stroke patient with repeated UEDVT, presenting superficial venous congestion, who was finally diagnosed with pulmonary adenocarcinoma. The cause of stroke was non-bacterial thromboembolism formed at the mitral valve. Our case shows that unexpected UEDVT should be closely evaluated for higher coagulable status such as a malignancy.

In acute stroke, emboli are mostly composed of thrombi from artery, cardiac chamber, valve and vein. Non-thrombotic emboli are sometimes difficult to identify the origin. According to the increased number of cancer patients, now 10% of stroke patients have a cancer. However, the potential mechanisms of stroke in patients with cancer are various. We presented a case of serious acute arterial occlusion with a tumor embolus, which was revealed by histopathologic analysis of retrieved emboli during mechanical thrombectomy.

The aim of this study was to investigate time trends in the public awareness of stroke and its predicting factors. The target population was 9,600 community-dwelling adults, aged 19–79 years, in 16 metropolitan cities and provinces in Korea. The survey samples in 2012 and 2014 were selected separately (entirely different sets of subjects) using a proportionate quota sampling method. Information concerning knowledge of stroke and demographics was collected by trained telephone interviewers using random digit dialing. After excluding subjects with a non-response or refusal to answer any question, the analyses included 8,191 subjects in 2012 and 8,127 subjects in 2014. Respondents’ awareness of stroke warning signs (numbness or weakness, difficulty speaking or understanding speech, dizziness, visual impairment, and severe headache) was highest for difficulty speaking or understanding speech (80.9% in 2012 and 86.4% in 2014). There were significant increases in the proportion of respondents understanding the appropriate action (i.e., calling an ambulance) at the time of stroke occurrence (59.6% to 67.1%), and in the proportion aware of the general need for prompt treatment (86.7% to 89.8%). In multivariable logistic regression analysis, older age, higher education level, higher household income, current non-smoking, exposure to stroke-related public relations materials, and experience of stroke education were significantly associated with both high knowledge of stroke warning signs and awareness of the need for prompt treatment. Between 2012 and 2014, the public’s awareness of stroke increased significantly. More specialized interventions, including public relations materials and education, should focus on subgroups who have lower stroke knowledge.
Adult ; Demography ; Dizziness ; Education ; Family Characteristics ; Health Services Needs and Demand ; Humans ; Interviews as Topic ; Korea* ; Logistic Models ; Methods ; Public Relations ; Stroke* ; Surveys and Questionnaires ; Telephone* ; Vision Disorders

Here we describe two cases of papillary urothelial neoplasm of low malignant potential in adolescent boys. One case was a 16-year-old boy with a polypoid mass beside the right ureteral orifice and the other case was a 13-year-old boy with a papillary mass beside the left ureteral orifice. The initial presentation was hematuria in both cases and the bladder mass was detected by ultrasonography. Complete resection of the bladder tumor was performed by using an 11-Fr pediatric resectoscope. Follow-up has been performed with urine analysis, urine cytology, and bladder ultrasonography or cystoscopy every 3 months with no evidence of recurrence.
Adolescent* ; Cystoscopy ; Follow-Up Studies* ; Hematuria ; Humans ; Male ; Recurrence ; Ultrasonography ; Ureter ; Urinary Bladder Neoplasms ; Urinary Bladder*

Recent global warming trends may have a significant impact on vector-borne viral diseases, possibly affecting vector population dynamics and disease transmission. This study measured levels of hemagglutination-inhibition (HI) antibodies against Japanese encephalitis virus (JEV) and neutralizing antibodies against Akabane virus (AKAV) and Aino virus (AINV) for Thoroughbred horses in Korea. Blood samples were collected from 989 racehorses in several provinces, between October 2005 and March 2007. Sera were tested using either an HI assay or a virus neutralization test. Approximately half (49.7%; 492/989) of the horses tested were antibody-positive for JEV. The HI titer against JEV was significantly correlated with racehorse age (p < 0.05). Horses with an HI antibody titer of 1: 160 or higher accounted for 3.9% of the animals tested, indicating that vectors transmitting arthropod- borne viruses bit relatively few horses. In contrast, 3.8% (19/497) and 19.5% (97/497) of horse sera collected in March 2007 were positive against AKAV and AINV, respectively. The presence of antibodies against AKAV and AINV may indicate the multiplication of AKAV and AINV in these horses.
Aging ; Animals ; Encephalitis Virus, Japanese/*isolation & purification ; Hemagglutination Inhibition Tests/veterinary ; Horse Diseases/blood/*epidemiology ; Horses ; Korea/epidemiology ; Orthobunyavirus/*isolation & purification ; Seroepidemiologic Studies

Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare complications after pacemaker implantation.
Aged ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Ventricles* ; Humans ; Radiography ; Thorax

OBJECTIVE: In permanent distal middle cerebral artery occlusion (pdMCAO) model of rats, the temporal order of subcellular translocation is not fully understood yet. We studied translocation sequence of cytochrome c and apoptosis inducing factor (AIF) after pdMCAO and patterns of expression. METHODS: Twenty-one male rats - with ten minutes, 1, 4, 8, 24 and 48 hours of pdMCAO groups - were enrolled. At core and penumbra area of each cerebral cortex, Western blotting of cytochrome c and AIF were performed using cytosolic fractions and then compared with sham specimens. With 48 hours group, the expression of cytochrome c and AIF was examined with immunofluorescent staining. RESULTS: Compared to sham, the cytosolic translocation of cytochrome c significantly increased at all time points (p<0.05). As early as 10 min after onset of ischemia, it was increased significantly (p<0.01). The cytosolic translocation of AIF showed gradual increase with the passage of time and significantly increased 8 hours after (p<0.05). As late as 24 hours and 48 hours after onset of ischemia, there were increased most significantly (p<0.01). At penumbra, both proteins failed to show significant increase at all time points. At 48 hours after ischemia, colocalization of cytochrome c and AIF were confirmed. CONCLUSION: Cytosolic translocation of cytochrome c peaks much earlier than that of AIF in pdMCAO model of rat. Caspase dependent apoptosis activates soon after ischemia and later, it can be reinforced by gradually increasing AIF in ischemic core.
Animals ; Apoptosis ; Apoptosis Inducing Factor ; Blotting, Western ; Cerebral Cortex ; Cytochromes c ; Cytosol* ; Humans ; Infarction, Middle Cerebral Artery* ; Ischemia ; Male ; Middle Cerebral Artery* ; Mitochondrial Proteins* ; Rats*

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

BACKGROUND: Thyroid ultrasonography can accurately detect nonpalpable nodules, estimate the size of the nodule during follow-up, and discriminate between solid nodules and simple cysts. Many studies have recently been done to detect malignant thyroid nodules by high-resolution ultrasonography. However, the exact role of high-resolution ultrasonography in distinguishing benign from malignant nodules is still unresolved. We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography. METHODS: We retrospectively analyzed the sonographic feature of thyroid nodules in patients who had been examined with fine-needle aspiration cytology or had surgery for a thyroid nodule at St. Mary's Hospital, Korea from January 2003 to January 2005. Sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as category 3 (malignant). If a nodule had none of the features described, it was classified as category 2 (benign). Anechogenic cystic nodule was classified as category 1 (benign). RESULTS: Of 124 lesions classified as category 3, 60 were malignant. Of 418 lesions classified as category 1 or 2, 409 was benign. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy based on sonographic classification method were 90%, 86.5%, 48.4%, 97.8%, 86.5%, respectively. CONCLUSIONS: Our results identified sonographic classification with calcification, margin, echogenicity and shape as useful tool in the differentiation of malignant from benign nodule. In view of the high value of negative predictive value of sonographic classification, a more aggressive approach is recommended only for nodules with category 3.
Biopsy, Fine-Needle ; Classification ; Humans ; Korea ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*