BACKGROUND AND PURPOSE: The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF). METHODS: This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0–3.0] and additionally by the proportion of INR values within the therapeutic range. RESULTS: The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5% were female, and their CHA₂DS₂-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1% (95% confidence interval, 47.9–50.3%), and the TTR quartiles were <34.5, 34.5–49.1, 49.1–64.5%, and >64.5%. None of the 16 centers achieved a mean TTR of >60%. Of all INR measurements, 44.6% were within the therapeutic range, 41.7% were <2.0, and 13.7% were >3.0. CONCLUSIONS: In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.
Atrial Fibrillation* ; Cohort Studies ; Embolism ; Female ; Humans ; International Normalized Ratio ; Observational Study* ; Retrospective Studies* ; Stroke* ; Warfarin*

This article provides an overview of the developmental history and rationale of medical ethics to establish the code of ethics and professional conduct of the Korean Academy of Child and Adolescent Psychiatry (KACAP). Most medical professional organizations have their own codes of ethics and conduct because they have continuous responsibility to regulate professional activities and conducts for their members. The Ethics and Award Committee of the KACAP appointed a Task-Force to establish the code of ethics and conduct in 2012. Because bioethics has become global, the Ethics Task Force examined global standards. Global standards in medical ethics and professional conduct adopted by the World Medical Association and the World Psychiatric Association have provided the basic framework for our KACAP's code of ethics and professional conduct. The Code of Ethics of the Americal Academy of Child and Adolescent Psychiatry has provided us additional specific clarifications required for child and adolescent patients. The code of ethics and professional conduct of the KACAP will be helpful to us in ethical clinical practice and will ensure our competence in recognizing ethical violations.
Adolescent ; Adolescent Psychiatry* ; Adolescent* ; Advisory Committees ; Awards and Prizes ; Bioethics ; Child* ; Codes of Ethics ; Ethics ; Ethics, Medical* ; Humans ; Mental Competency ; Societies

Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. After admission, he underwent sigmoidoscopy, which revealed multiple ulcerations with yellowish exudate in the rectum and sigmoid colon. The patient was treated with ciprofloxacin and metronidazole. After one week, follow up sigmoidoscopy was performed owing to sustained fever and diarrhea. The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa. Abdominal computed tomography and rectal magnetic resonance imaging were performed, and showed a perianal and perirectal abscess. The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage. Extended-spectrum beta-lactamase-producing K. pneumoniae was identified in pus culture. The antibiotics were switched to ertapenem. He improved after surgery and was discharged. K. pneumoniae can cause rapid invasive infection in patients with diabetes and a history of alcohol abuse. We report the first rare case of proctitis and perianal abscess caused by invasive K. pneumoniae infection.
Abscess* ; Alcoholism ; Anti-Bacterial Agents ; Ciprofloxacin ; Colon, Sigmoid ; Colostomy ; Diabetes Mellitus ; Diarrhea ; Drainage ; Exudates and Transudates ; Fever ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae* ; Magnetic Resonance Imaging ; Metronidazole ; Middle Aged ; Mucous Membrane ; Pneumonia ; Proctitis* ; Rectum ; Sigmoidoscopy ; Suppuration ; Ulcer

The aim of the current Part II of Stroke Statistics in Korea is to summarize nationally representative data on public awareness, pre-hospital delay, thrombolysis, and quality of acute stroke care in a single document. The public's knowledge of stroke definition, risk factors, warning signs, and act on stroke generally remains low. According to studies using open-ended questions, the correct definition of stroke was recognized in less than 50%, hypertension as a stroke risk factor in less than 50%, and other well-defined risk factors in less than 20%. Among stroke warning signs, sudden paresis or numbness was best appreciated, with recognition rates ranging in 36.9-73.7%, but other warning signs including speech disturbance were underappreciated. In addition, less than one third of subjects in a representative population survey were aware of thrombolysis and had knowledge of the appropriate act on stroke, calling emergency medical services (EMS). Despite EMS being an essential element in the stroke chain of survival and outcome improvement, EMS protocols for field stroke diagnosis and prehospital notification for potential stroke patients are not well established. According to the Assessment for Quality of Acute Stroke Care, the median onset-to-door time for patients arriving at the emergency room was 4 hours (mean, 17.3 hours) in 2010, which was not reduced compared to 2005. In contrast, the median door-to-needle time for intravenous tissue plasminogen activator (IV-TPA) treatment was 55.5 minutes (mean, 79.5 minutes) in 2010, shorter than the median time of 60.0 minutes (mean, 102.8 minutes) in 2008. Of patients with acute ischemic stroke, 7.9% were treated with IV-TPA in 2010, an increase from the 4.6% in 2005. Particularly, IV-TPA use for eligible patients substantially increased, from 21.7% in 2005 to 74.0% in 2010. The proportion of hospitals equipped with a stroke unit has increased from 1.1% in 2005 to 19.4% in 2010. Performance, as measured by quality indicators, has steadily improved since 2005, and the performance rates for most indicators were greater than 90% in 2010 except for early rehabilitation consideration (89.4%) and IV-TPA use for eligible patients (74.0%). In summary, the current report indicates a substantial improvement in in-hospital acute stroke care, but also emphasizes the need for enhancing public awareness and integrating the prehospital EMS system into acute stroke management. This report would be a valuable resource for understanding the current status and implementing initiatives to further improve public awareness of stroke and acute stroke care in Korea.
Emergencies ; Emergency Medical Services ; Humans ; Hypertension ; Hypesthesia ; Korea ; Paresis ; Quality Indicators, Health Care ; Risk Factors ; Stroke ; Tissue Plasminogen Activator

The aim of the Part I of Stroke Statistics in Korea is to summarize nationally representative data of the epidemiology and risk factors of stroke in a single document. Every year, approximately 105,000 people experience a new or recurrent stroke and more than 26,000 die of stroke, which indicates that every 5 minutes stroke attacks someone and every 20 minutes stroke kills someone in Korea. Stroke accounts for roughly 1 of every 10 deaths. The estimated stroke prevalence is about 795,000 in people aged > or =30 years. The nationwide total cost for stroke care was 3,737 billion Korean won (US$3.3 billion) in 2005. Fortunately, the annual stroke mortality rate decreased substantially by 28.3% during the first decade of the 21th century (53.2/100,000 in 2010). Among OECD countries, Korea had the lowest in-hospital 30-day case-fatality rate for ischemic stroke and ranked third lowest for hemorrhagic stroke in 2009. The proportion of ischemic stroke has steadily increased and accounted for 76% of all strokes in 2009. According to hospital registry studies, the 90-day mortality rate was 3-7% for ischemic stroke and 17% for intracerebral hemorrhage. For risk factors, among Korean adults > or =30 years of age, one in 3-4 has hypertension, one in 10 diabetes, and one in 7 hypercholesterolemia. One in 3 Korean adults > or =19 years of age is obese. Over the last 10 years, the prevalence of hypertension slightly decreased, but the prevalence of diabetes, hypercholesterolemia, and obesity increased. Smoking prevalence in men has decreased, but is still as high as 48%. This report could be a valuable resource for establishing health care policy and guiding future research directions.
Adult ; Aged ; Cerebral Hemorrhage ; Delivery of Health Care ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Male ; Obesity ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Stroke

Klinefelter's syndrome which is characterized by hypogonadism with karyotype abnormality (47 XXY or 46 XY/47 XXY) in males has been reported to be associated with autoimmune diseases including rheumatoid arthritis and systemic lupus erythematosus. However, Klinefelter's syndrome accompanying with polymyositis has rarely been reported. We report a case of KFS with polymyosits in a 38-year old man for the first time in Korea.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Humans ; Hypogonadism ; Karyotype ; Klinefelter Syndrome ; Korea ; Lupus Erythematosus, Systemic ; Male ; Polymyositis

STUDY DESIGN: A retrospective study. OBJECTIVES: We attempted to establish an efficient diagnosis and treatment modality by analyzing clinical manifestations and operative results of upper lumbar disc herniations. SUMMARY OF LITERATURE REVIEW: Upper lumbar disc herniations represented a lower incidence but have become easier to diagnose by predictable clinical aspects and an MRI scan. The operative results have been satisfactory. MATERIALS AND METHODS: We evaluated 41 cases, which were operated with posterior laminectomy and discectomy from September, 1996 to November, 2009. We analyzed pre-operative history, clinical and MRI findings, and then assessed operative results by Kim's criteria and functional change in the follow up. RESULTS: The prevalence of upper lumbar disc herniations in all disc herniations was 8.8%. Pre-operative manifestations were lower back pain (85.4%), radiating pain (80.5%), sensory deficit (53.7%), motor deficit (53.7%), and depressed knee jerk (65.9%). The positive rate of the femoral stretching test (78.0%) was higher than the straight leg raising test (39.0%). The VAS score changed from preoperative 9.0+/-0.8 into postoperative 1.4+/-1.3 points. The operative results were excellent or good in 82.9%. The rate of resuming previous work, including slight modification was 90.2%. CONCLUSIONS: Predictable clinical aspects of the upper lumbar disc herniations are anterior thigh pain with lower back pain, variable motor deficit, sensory deficit, depressed knee jerk and the positive femoral nerve stretching test. Through careful examination and radiological evaluations such as MRI, operative treatment can obtain a symptomatic improvement and satisfactory results.
Diskectomy ; Femoral Nerve ; Incidence ; Knee ; Laminectomy ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Thigh

PURPOSE: Kidney size (KS) is used to diagnose the patients with renal disease. When the length of a kidney is measured under 9 cm, it is considered to indicate an irreversible disease. Because glomerular filtration rate (GFR) decreases with age, the normal range of KS in the elderly is indefinite. Therefore, we measured KS in adults older than 80 years old and investigated correlated factors. METHODS: One hundreds six adults (51 men, 55 women: mean age 83+/-0.3) without renal disease were included. Their serum creatinine (Scr) levels did not exceed 1.3 mg/dL, and the calculated GFR were over 60 mL/min/1.73m2. Abdominal ultrasonography were performed to all of them and their body indexes (BI) were measured. RESULTS: 1) The mean length of kidney was 9.9+/-0.07 cm. 2) KS in the early eighties was larger than that of adults over ninety. 3) KS showed negative correlations with age and Scr, but a positive correlation with body surface area . 4) The calculated GFR showed correlations with the surface areas of both kidney (BK) by C-G equation and with the size of BK by MDRD equation. 4) The GFR calculated by MDRD and C-G equation presented inverse correlations with Scr, but only MDRD equation showed a statistic significance. CONCLUSION:In the elderly, KS may be smaller than that of younger adults. Other factors such as either surface area or volume of BK and BI should be considered to estimate the individual KS to decide whether the size is within normal range.
Adult ; Aged ; Body Size ; Body Surface Area ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney ; Male ; Organ Size ; Reference Values

PURPOSE: The change of quality of life following a tension-free vaginal tape (TVT) and transobturator vaginal tape (TVT-O) procedure was investigated in patients with stress urinary incontinence. MATERIALS AND METHODS: We included 86 women with stress urinary incontinence who underwent the TVT or TVT-O procedure and followed up for at least 1 year. Preoperatively, the patients were evaluated with history taking, physical examination, urodynamics to determine abdominal leak point pressure (ALPP) and pre- and postoperative quality of life was evaluated by incontinence quality of life questionnaire (I-QoL). The success after operation was defined as the absence of any subjective complaint of leakage. RESULTS: The rate of cure of TVT and TVT-O procedure were 84%, 92% and the rate of improvement of them were 16%, 8%, respectively. Preoperative patient characteristics including uroflowmetric parameters and ALPP were comparable in the two groups. The I-QoL parameters one year after surgery were statistically significant increase in I-QoL scores in each groups. There were no serious or long-term complications related to both procedures. CONCLUSIONS: These data suggest that the TVT and TVT-O procedure are effective for treating female stress incontinence and also in the aspect of improving quality.
Female ; Humans ; Physical Examination ; Quality of Life* ; Surveys and Questionnaires ; Suburethral Slings* ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: The objectives of this study was to compare the efficacy of antibiotic monotherapy with antibiotic plus alpha-blocker combination therapy for the treatment of inflammatory chronic pelvic pain syndrome (CPPS) patients. MATERIALS AND METHODS: Between October 2005 and May 2006, 69 patients who were diagnosed as CPPS(National Institutes of Health; NIH-catagory IIIa), were included in this study. The patients were randomly placed into two groups: group I was treated with gatifloxacin alone(35 patients), and group II was treated with gatifloxacin and doxazosin(34 patients) for 6 weeks. For all the patients, the urinalysis, expressed prostatic massage, the National Institute of Health-Chronic Prostatitis Symptom Index(NIH-CPSI) and a distal rectal examination(DRE) were performed at the initial visit. The NIH-CPSI was compared both before and after the treatment. RESULTS: On the initial diagnosis, the mean CPSI of the group I patients was 24.0+/-6.3, and that for the group II patients was 24.7+/-6.9. After the treatment, that of the group I was 16.6+/-5.4, and that of group II was 13.4+/-5.3. After 6 weeks of treatment, the changes in the total CPSI scores had significantly improved in group II compared with group I(p<0.05). A statistically significant improvement occurred in the pain score, the voiding symptom score and the quality of life in the group II compared with group I(p<0.05) CONCLUSIONS: This study suggests that combination therapy of antibiotic plus alpha-blocker would be more effective than antibiotic monotheraphy for treating patients with inflammatory chronic prostatitis/chronic pelvic pain syndrome.
Academies and Institutes ; Adrenergic alpha-Antagonists ; Anti-Bacterial Agents ; Fluoroquinolones ; Humans ; Massage ; Pelvic Pain ; Prostatitis ; Quality of Life ; Urinalysis