Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

BACKGROUND: A rate of traffic accidents by elderly drivers increased by 70% between 2011 and 2015 in Korea. Elderly drivers with cognitive impairment are more susceptible to be involved traffic accidents than cognitively normal individuals. This study aimed to evaluate the correlation of driving-related cognition and cognitive impairment in drivers over the age of 60 using the standardized program developed by the Road Traffic Authority (RTA). METHODS: Current drivers older than 60 years were recruited for the study. All participants were tested using the Mini-Mental Status Examination (MMSE), Rey Complex Figure Test (RCFT)-copy, and Digit Symbol Substitution Test (DSST) for cognitive function assessments. The driving aptitude test (DAT) for the elderly developed by RTA consists of 4 different tasks including speed and distance driving tests (SD), visuospatial memory driving tests (VM), sustained attention driving tests (SA), and divided attention driving tests (DA). The participants were divided into two groups by their MMSE score (normal cognition, CN; cognitive impairment, CI). RESULTS: One hundred fourteen participants were enrolled in the study and 57 of them were assigned to the CI group. In comparison, drivers in CI showed worse scores at DSST, SD, VM, and DA than those in CN. DSST and DA were worsened with increasing age. DSST was the best predictive assessment to be the risk or caution grade in DAT. CONCLUSIONS: We could find a correlation between DAT and cognitive function in drivers over the age 60. These results could be used as the basis of investigating optimal tools for decreasing driving risks in the cognitive impaired elderly.
Accidents, Traffic ; Aged ; Aptitude Tests ; Cognition Disorders ; Cognition ; Humans ; Korea ; Memory

BACKGROUND: Carpal tunnel syndrome (CTS) is defined by symptoms associated with damage to the median nerve within the carpal tunnel. Abnormal sensation in the median nerve territory is one of the primary clinical diagnostic criteria for CTS. However, extramedian sensory abnormalities in CTS are common. The purpose of this study was to identify the clinical significance of the paresthesia distribution in CTS. METHODS: This was a cross-sectional retrospective study involving patients with CTS diagnosed based on the American Academy of Neurology criteria between January 2009 and January 2011. In total, 109 hands of 57 enrolled patients were analyzed. The participants were divided into two groups according to the distribution of sensory abnormalities: (1) sensory symptoms confined to the median nerve distribution (median group), and (2) sensory symptoms distributed diffusely over the entire hand (glove group). Clinical features and electrophysiological findings were investigated by thorough chart reviews. RESULTS: Forty-seven (43.1%) hands belonged to the glove group. The frequency of sensory abnormalities and motor weakness was higher in the median group (38.7 vs 9.7%) than in the glove group (12.8% vs. 0.0%) on neurological examination. The conduction velocities of sensory nerves of the wrist and finger were significantly slower in the median group than in the glove group. CONCLUSIONS: Evaluation of the sensory symptom distribution in CTS may predict the degree of nerve damage, with sensory abnormality restricted to the median nerve distribution reflecting more severe nerve damage in CTS.
Carpal Tunnel Syndrome ; Fingers ; Hand ; Humans ; Median Nerve ; Neurologic Examination ; Neurology ; Paresthesia ; Retrospective Studies ; Sensation ; Wrist

Non-islet cell tumor-induced hypoglycemia (NICTH) is associated with mesenchymal tumor types, including hemangiopericytoma, fibrosarcoma, mesothelioma, and neurofibroma, as well as carcinoma of the liver, adrenal glands, and kidneys. Non-islet cell tumors induce hypoglycemia by overproducing an abnormal form of insulin-like growth factor II (IGF II). Complete removal of the tumor or reduction of the tumor mass is a successful therapeutic strategy in cases of NICTH. However, if the tumor re-grows, curative resection is nearly impossible, and hypoglycemia occurs repeatedly. Glucocorticoids are effective in terms of long-term relief from hypoglycemia through promotion of gluconeogenesis in the liver, tumor suppression, production of 'big'-IGF-II, and correction of the attendant biochemical abnormalities involving the growth hormone (GH)-IGF axis. We found that administration of corticosteroid therapy to a patient suffering from NICTH resulted in improvement of hypoglycemia associated symptoms.
Adrenal Glands ; Axis, Cervical Vertebra ; Fibrosarcoma ; Glucocorticoids ; Gluconeogenesis ; Growth Hormone ; Hemangiopericytoma ; Humans ; Hypoglycemia ; Insulin-Like Growth Factor II ; Kidney ; Liver ; Mesothelioma ; Neurofibroma ; Prednisolone ; Stress, Psychological

Rhabdomyosarcomas are soft tissue sarcomas; while extremely rare in adults, they are one of the most common neoplasms in children and adolescents. Histologically, they can be classified into embryonal(ERMS), alveolar(ARMS), pleomorphic, and undifferentiated types. The ARMS type is very rare, and is associated with a poor prognosis. Common primary sites of ARMS are the trunk and extremities. We report on a case of paraaortic, supraclavicular, and axillary lymph node metastasis from paratesticular ARMS treated with VAC(vincristine, dactinomycin, cyclophosphamide)/ IE(ifosfamide, etoposide) chemotherapy in a young adult. Administration of six cycles of chemotherapy with VAC/ IE resulted in complete remission. The patient has maintained complete remission over the past 27 months.
Adolescent ; Adult ; Arm ; Child ; Dactinomycin ; Extremities ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Metastasis ; Prognosis ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Alveolar ; Young Adult

BACKGROUND/AIMS: Although inpatient hematology consultations have recently increased, the reasons for consultation, as well as the impact of inpatient hematologic consultations, are not clear. Therefore, we assessed patient profiles, the reasons for hematology consultations, and diagnoses at our hospital. METHODS: We evaluated 177 consecutive patients with hematology problems seen between March 2004 and February 2005. For each, we assessed the reason for the consultation, patient diagnosis, and outcome. RESULTS: Of 28,854 inpatients in our hospital, 177 (0.6%) required consultations for hematology problems. Of these 177 inpatients, 85 (48%) were male and 92 (52%) were female; their median age was 55 years (range 16-85 years), with the most frequent age group being patients 61-70 years old. Hematology consultations were requested by the neurosurgery (25%), general surgery (11%), internal medicine (10%), neurology (10%), and orthopedics (9%) departments. The most common reasons for consultation were anemia (29%), thrombocytopenia (21%), pancytopenia/bicytopenia (16%), coagulation abnormalities (14%), and thrombocytosis (5%). In one-third of these consultations, the hematologic abnormality was detected after admission and most were resolved successfully. The most common cause of anemia was iron deficiency (43%). Drug-induced thrombocytopenia and pancytopenia were also common (20%), and were thought to be due to anticonvulsants and antibiotics. Bone marrow examination was required in 19 patients (11%). Careful examination detected bleeding of the gastrointestinal tract, or liver or hematologic diseases, such as chronic myeloproliferative disorders, in some of these patients. CONCLUSIONS: Although it provides a small cross-sectional survey of the types of patient and problems seen by hematologists during in-patient consultations, this information may help to improve patient care and the quality of hematology consultations.
Anemia ; Anti-Bacterial Agents ; Anticonvulsants ; Bone Marrow Examination ; Cross-Sectional Studies ; Gastrointestinal Tract ; Hematologic Diseases ; Hematology ; Hemorrhage ; Humans ; Inpatients ; Internal Medicine ; Iron ; Liver ; Male ; Myeloproliferative Disorders ; Neurology ; Neurosurgery ; Orthopedics ; Pancytopenia ; Patient Care ; Referral and Consultation ; Thrombocytopenia ; Thrombocytosis

Background: DNA prevalence and type distribution of human papillomavirus (HPV) varies geographically. We investigated HPV prevalence and type distribution in Korean women using the MyHPV DNA chip testing. Methods: A total of 2,368 women from five regions of the country underwent Pap smear examination and MyHPV chip testing. Results: Overall HPV positivity was 15.8% and 78.4% in women with normal and abnormal cytology, respectively. High-risk HPV infection was strongly correlated with cytological atypia. In women with abnormal cytology, the five most common HPV types were 16, 58, 18, 52, and 56/53, and HPV16 was significantly the most common type in most geographical regions. After HPV16, HPV58, and 52 were the next most frequently detected types. Women with normal cytology, in contrast, showed heterogeneity in HPV type distribution. High-grade intraepithelial lesions infected with HPV16, 18, 31 or 45 are more likely to progress to carcinoma. Conclusions: The HPV chip test can provide useful data regarding HPV positivity and type. The most common HPV type in Korean women with abnormal cytology is HPV16, with HPV58 and 52 being frequently present. Our data may have important implications for vaccination programs and the development of cervical screening.
Cervix Uteri ; DNA ; Female ; Genotype ; Humans ; Mass Screening ; Oligonucleotide Array Sequence Analysis ; Population Characteristics ; Prevalence ; Republic of Korea ; Vaccination ; Vaginal Smears

Posttransplantation lymphoproliferative disorder (PTLD) is a potentially fatal complication of hematopoietic stem cell transplantation (HPSCT) that occurs relatively early after the transplantation. The occurrence of PTLD is usually associated with Epstein-Barr virus (EBV) infection in patients who are treated by aggressive immunosuppressive therapy. PTLD presents as diverse manifestations, ranging from reactive lymphoid hyperplasia to high grade malignant lymphoma. In the present work, we describe a case of PTLD that was successfully treated with R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) chemotherapy in a 21-year-old female who received HLA-matched sibling HPSCT for severe aplastic anemia. At 120 days after transplantation, she had symptoms of dysphagia and a foreign body sensation in the throat and was diagnosed as PTLD, diffuse large B cell lymphoma involving a tonsil, cervical lymph nodes, an adrenal gland, and the liver. Three courses of R-CHOP resulted in complete remission.
Adrenal Glands ; Anemia, Aplastic ; Antibodies, Monoclonal, Murine-Derived ; Antineoplastic Combined Chemotherapy Protocols ; Cyclophosphamide ; Deglutition Disorders ; Doxorubicin ; Female ; Foreign Bodies ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Herpesvirus 4, Human ; Humans ; Liver ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell ; Lymphoproliferative Disorders ; Palatine Tonsil ; Pharynx ; Prednisone ; Pseudolymphoma ; Sensation ; Siblings ; Stem Cell Transplantation ; Transplants ; Vincristine ; Young Adult ; Rituximab

Posttransplantation lymphoproliferative disorder (PTLD) is a potentially fatal complication of hematopoietic stem cell transplantation (HPSCT) that occurs relatively early after the transplantation. The occurrence of PTLD is usually associated with Epstein-Barr virus (EBV) infection in patients who are treated by aggressive immunosuppressive therapy. PTLD presents as diverse manifestations, ranging from reactive lymphoid hyperplasia to high grade malignant lymphoma. In the present work, we describe a case of PTLD that was successfully treated with R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) chemotherapy in a 21-year-old female who received HLA-matched sibling HPSCT for severe aplastic anemia. At 120 days after transplantation, she had symptoms of dysphagia and a foreign body sensation in the throat and was diagnosed as PTLD, diffuse large B cell lymphoma involving a tonsil, cervical lymph nodes, an adrenal gland, and the liver. Three courses of R-CHOP resulted in complete remission.
Adrenal Glands ; Anemia, Aplastic ; Antibodies, Monoclonal, Murine-Derived ; Antineoplastic Combined Chemotherapy Protocols ; Cyclophosphamide ; Deglutition Disorders ; Doxorubicin ; Female ; Foreign Bodies ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Herpesvirus 4, Human ; Humans ; Liver ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell ; Lymphoproliferative Disorders ; Palatine Tonsil ; Pharynx ; Prednisone ; Pseudolymphoma ; Sensation ; Siblings ; Stem Cell Transplantation ; Transplants ; Vincristine ; Young Adult ; Rituximab

Instant noodle is one of the most popular foods in Korea. The objective of this study was to examine the association of instant noodle consumption and food and nutrient intake among children and teenagers in Korea. We used dietary data from 24-h recall of 1,748 subjects aged 7-19 years who participated in the 2005 Korea National Health and Nutrition Examination Survey. Those who consumed instant noodle once or more during the survey period were categorized as "instant noodle consumer (INC)" and were compared for food and nutrient intakes with the others (non-INC). The average age of the INC was 13.4 and that of the non-INC was 12.4; girls consumed more instant noodles than boys (p < 0.05). There was no significant difference in BMI between the two groups. With the exception of grains, as compared to the non-INC, the INC consumed significantly less amounts of potatoes, vegetables, mush-rooms, fruits, spices, seafood, and milk and dairy products. With respect to nutrient intakes, the INC-group showed significantly higher nutrient intakes of energy, fat, carbohydrate, sodium, thiamine, and riboflavin; however, as compared to the non-INC-group, the INC-group showed significantly less intakes of calcium, niacin, and vitamin C. The overall result suggests that consuming instant noodles may lead to excessive intake of fat and sodium, but it may cause an increased intake of thiamine and riboflavin. Therefore, nutrition education that helps children and teenagers choose a balanced meal while consuming instant noodle should be carried out. In addition, manufactures of instant noodles should consider nutritional aspects in product development processes.
Adolescent ; Aged ; Ascorbic Acid ; Calcium ; Child ; Dairy Products ; Edible Grain ; Fruit ; Humans ; Korea ; Meals ; Milk ; Niacin ; Nutrition Surveys ; Riboflavin ; Seafood ; Sodium ; Solanum tuberosum ; Spices ; Thiamine ; Vegetables