Background: There was an important revision of the Korean Clinical Practice Guideline for Stroke (KCPGS) for antithrombotic therapy in patients with acute ischemic stroke in 2022. This review is to provide an updated information in this revision. Methods: The revision history by year after the first announcement was examined for each topic, focusing on antithrombotic therapy duringacute phase which was revised in 2022. We compared before and after the revision, and investigated the clinical outcomes presented as evidence. It was also compared with the current U.S. guidelines. Results: The major changes about antiplatelet therapy are a clause stating that dual antiplatelet therapy with clopidogrel and aspirin initiated within 24 hours from the stroke onset and maintained for up to 21-30 days is recommended as an acute treatment, as well as the clause that antithrombotic therapy may be initiated within 24 hours after intravenous thrombolytics and that the use of glycoprotein IIb/IIIa receptor antagonists can be considered inhighly selected patients as rescue therapy taking into account of benefit and risk. The change to the use of anticoagulants is that itmay be reasonable to start oral anticoagulant between 4 and 14 days after stroke onset for patients with acute ischemic stroke and atrial fibrillation. Conclusions It will be helpful in improving health outcomes for clinical pharmacists to be aware of the latest information for antithrombotic therapy and to actively use it in pharmaceutical care of stroke patients.

Background: There was an important revision of the Korean Clinical Practice Guideline for Stroke (KCPGS) for antithrombotic therapy in patients with acute ischemic stroke in 2022. This review is to provide an updated information in this revision. Methods: The revision history by year after the first announcement was examined for each topic, focusing on antithrombotic therapy duringacute phase which was revised in 2022. We compared before and after the revision, and investigated the clinical outcomes presented as evidence. It was also compared with the current U.S. guidelines. Results: The major changes about antiplatelet therapy are a clause stating that dual antiplatelet therapy with clopidogrel and aspirin initiated within 24 hours from the stroke onset and maintained for up to 21-30 days is recommended as an acute treatment, as well as the clause that antithrombotic therapy may be initiated within 24 hours after intravenous thrombolytics and that the use of glycoprotein IIb/IIIa receptor antagonists can be considered inhighly selected patients as rescue therapy taking into account of benefit and risk. The change to the use of anticoagulants is that itmay be reasonable to start oral anticoagulant between 4 and 14 days after stroke onset for patients with acute ischemic stroke and atrial fibrillation. Conclusions It will be helpful in improving health outcomes for clinical pharmacists to be aware of the latest information for antithrombotic therapy and to actively use it in pharmaceutical care of stroke patients.

Background: There was an important revision of the Korean Clinical Practice Guideline for Stroke (KCPGS) for antithrombotic therapy in patients with acute ischemic stroke in 2022. This review is to provide an updated information in this revision. Methods: The revision history by year after the first announcement was examined for each topic, focusing on antithrombotic therapy duringacute phase which was revised in 2022. We compared before and after the revision, and investigated the clinical outcomes presented as evidence. It was also compared with the current U.S. guidelines. Results: The major changes about antiplatelet therapy are a clause stating that dual antiplatelet therapy with clopidogrel and aspirin initiated within 24 hours from the stroke onset and maintained for up to 21-30 days is recommended as an acute treatment, as well as the clause that antithrombotic therapy may be initiated within 24 hours after intravenous thrombolytics and that the use of glycoprotein IIb/IIIa receptor antagonists can be considered inhighly selected patients as rescue therapy taking into account of benefit and risk. The change to the use of anticoagulants is that itmay be reasonable to start oral anticoagulant between 4 and 14 days after stroke onset for patients with acute ischemic stroke and atrial fibrillation. Conclusions It will be helpful in improving health outcomes for clinical pharmacists to be aware of the latest information for antithrombotic therapy and to actively use it in pharmaceutical care of stroke patients.

Background: There was an important revision of the Korean Clinical Practice Guideline for Stroke (KCPGS) for antithrombotic therapy in patients with acute ischemic stroke in 2022. This review is to provide an updated information in this revision. Methods: The revision history by year after the first announcement was examined for each topic, focusing on antithrombotic therapy duringacute phase which was revised in 2022. We compared before and after the revision, and investigated the clinical outcomes presented as evidence. It was also compared with the current U.S. guidelines. Results: The major changes about antiplatelet therapy are a clause stating that dual antiplatelet therapy with clopidogrel and aspirin initiated within 24 hours from the stroke onset and maintained for up to 21-30 days is recommended as an acute treatment, as well as the clause that antithrombotic therapy may be initiated within 24 hours after intravenous thrombolytics and that the use of glycoprotein IIb/IIIa receptor antagonists can be considered inhighly selected patients as rescue therapy taking into account of benefit and risk. The change to the use of anticoagulants is that itmay be reasonable to start oral anticoagulant between 4 and 14 days after stroke onset for patients with acute ischemic stroke and atrial fibrillation. Conclusions It will be helpful in improving health outcomes for clinical pharmacists to be aware of the latest information for antithrombotic therapy and to actively use it in pharmaceutical care of stroke patients.

Purpose: The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmentation using suture tapes (ST). Materials and Methods: Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m2 ; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation. Results: FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports activity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%) . There was significant improvement in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001). Conclusion The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician’s preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.
Adult ; Ankle Joint ; Ankle ; Humans ; Knee ; Lipoma ; Lipomatosis ; Magnetic Resonance Imaging ; Synovial Membrane ; Tendons

PURPOSE: Granulocyte colony stimulating factor (G-CSF) has been known to increase neutrophil production and have anti-inflammatory properties, but the effect of G-CSF on pulmonary system is in controversy. We investigated whether G-CSF treatment could attenuate hyperoxia-induced lung injury, and whether this protective effect is mediated by the down-modulation of inflammatory responses in a neonatal rat model. MATERIALS AND METHODS: Newborn Sprague-Dawley rats (Orient Co., Seoul, Korea) were subjected to 14 days of hyperoxia (90% oxygen) beginning within 10 h after birth. G-CSF (20 microg/kg) was administered intraperitoneally on the fourth, fifth, and sixth postnatal days. RESULTS: This treatment significantly improved hyperoxia-induced reduction in body weight gain and lung pathology such as increased mean linear intercept, mean alveolar volume, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling positive cells. Hyperoxia-induced activation of nicotinamide adenine dinucleotide phosphate oxidase, which is responsible for superoxide anion production, as evidenced by upregulation and membrane translocation of p67phox was significantly attenuated after G-CSF treatment, as were inflammatory responses such as increased myeloperoxidase activity and mRNA expression of transforming growth factor-beta. However, the attenuation of other proinflammatory cytokines such as tumor necrosis factor-alpha and interleukin-6 was not significant. CONCLUSION: In sum, G-CSF treatment significantly attenuated hyperoxia-induced lung injury by down-modulating the inflammatory responses in neonatal rats.
Animals ; Animals, Newborn ; Blotting, Western ; Female ; Granulocyte Colony-Stimulating Factor/*therapeutic use ; Hyperoxia/*complications ; In Situ Nick-End Labeling ; Interleukin-6/genetics ; Lung/*drug effects/*metabolism ; Lung Injury/*drug therapy/etiology/genetics/metabolism ; NADPH Oxidase/metabolism ; Peroxidase/metabolism ; Pregnancy ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Transforming Growth Factor beta/genetics ; Tumor Necrosis Factor-alpha/genetics ; Weight Gain/drug effects

Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels in skin, joints, gastrointestinal (GI) tract and kidney. GI symptoms occur in up to 85% of patients and may lead to severe problems such as intussusception, obstruction, and perforation. GI symptoms may not be easily controlled, showing refractoriness to the conventional corticosteroid therapy. Although GI involvements of HSP are acute, and self-limited in most instances, they may cause fatal results in some unusual cases. In such conditions all the possible therapeutic modalities should be considered. We report two cases of severe small bowel involvement of HSP. One case presented with severe abdominal pain showing refractoriness to corticosteroid, but improved with IV immunoglobulin therapy. In the second case, HSP with transmural infarction in the small bowel could be cured with surgical intervention.
Abdominal Pain ; Humans ; Immunization, Passive ; Immunoglobulins ; Infarction ; Intussusception ; Joints ; Kidney ; Purpura, Schoenlein-Henoch* ; Skin ; Vasculitis

Hyponatremia is commonly seen in those patients with central nervous system injury associated with infection or trauma. And decreasing intracranial pressure through restriction of maintenance fluid and salt is practiced as a routine therapeutic measure in the early stages of meningitis to prevent or ameliorate the syndrome of inappropriate secretion of antidiuretic hormone(SIADH). However, lots of patient do not show the typical symptoms of SIADH, instead they are dehydrated, have low plasma volume, increased urine sodium concentration and increased net sodium loss, which are the symptoms of cerebral salt wasting syndrome(CSW). Recent reports have prompted a reconsideration of CSW distinct from SIADH and moreover CSW has more proportion of hyponatremia associated with acute brain insult. CSW involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. While fluid restriction is the treatment of choice in SIADH, the treatment of CSW consists of vigorous sodium and volume replacement. And by correcting hyponatremic state as soon as possible, we can reduce mortality rate and improve neurologic sequelae. We report a case of CSW which was treated by replacement of vigorous sodium and volume replacement.
Brain ; Central Nervous System ; Child* ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Intracranial Pressure ; Meningitis* ; Mortality ; Plasma Volume ; Sodium ; Wasting Syndrome*