Moyamoya syndrome (MMS) associated with hyperthyroidism, such as Graves’ disease, is a rare condition that causes ischemic stroke with thyrotoxicity. A 43-year-old woman with symptoms of right hemiparesis was admitted. Brain magnetic resonance imaging revealed a small cerebral infarction in the left frontal lobe. Cerebral angiography revealed multi-vessel intracranial occlusive disease. Several days later, neurologic deterioration and aggravation of cerebral infarction developed due to a thyroid storm. A thyroid function test revealed the following: thyroid-stimulating hormone (TSH) ＜0.01 μunits/mL (reference range, 0.55–4.78 μunits/mL); triiodo-thyronine ＞8.0 ng/mL (reference range, 0.77–1.81 ng/mL); free thyroxine (T4) of 9.47 pmol/L (reference range, 11.4–22.6 pmol/L); and TSH receptor antibody of 37.10 U/L (reference range, 0–10 U/L). For thyroid storm management, we initiated treatment with methimazole, Gemstein’s solution, and hydrocortisone. Finally, the thyroid disease was controlled, and neurologic deficits improved. We describe a case of acute cerebral infarction combined with a thyroid storm in a patient with Moyamoya syndrome and Graves’ disease. Hyperthyroidism such as Graves’ disease should be considered in the differential diagnosis for patho-etiologic mechanisms associated with MMS. A cerebrovascular disease with a thyroid storm can lead to severe mortality and morbidity. Prompt diagnosis and strict treatment are important.

Objective: Cranioplasty (CP) and ventriculoperitoneal shunt (VPS) are required procedures following decompressive craniectomy (DC) for craniofacial protection and to prevent hydrocephalus. This study assessed the safety and efficacy of simultaneous operation with CP and VPS after DC, and determined the preoperative risk factors for postoperative complications. Methods: Between January 2009 and December 2019, 81 patients underwent CP and VPS in simultaneous or staged operations following DC. Cumulative medical records and radiologic data were analyzed using univariate analysis to identify factors predisposing patients to complications after CP and VPS. Results: CP and VPS were performed as simultaneous or staged operations in 18 (22.2%) and 63 (77.8%) patients, respectively. The overall postoperative complication rate was 16.0% (13/81). Patients who underwent simultaneous CP and VPS were significantly more likely to experience complications when compared with patients who underwent staged operations (33.3% vs. 9.6%, p<0.01). Univariate analysis revealed that simultaneous CP and VPS surgery was the only significant predictor of postoperative complications (p=0.031). Conclusion This study provided detailed data on surgical timing and complications for CP and VPS after DC. We showed that simultaneous procedures were a significant risk factor for postoperative complications.

BACKGROUND: The treatment success rates in patients with tuberculosis are known to be lower in the private sector compared to the public sector. To improve treatment outcomes in the private sector we developed a public-private collaboration model for strengthening health education and case holding activities with public health nursing in the private sector. METHODS: We performed a prospective cohort study in new smear positive pulmonary tuberculosis patients treated at private hospitals, selected by non-randomization, with an intervention consisting of health education and case holding activities by specially trained public health nurses (intervention group) results were compared with cases treated without the intervention (conventional group). Physicians were asked to treat both groups routinely. The treatment outcomes of patients under treatment by the National Tuberculosis Programme were also analyzed for comparison. RESULTS: There were 172 cases each in the intervention and conventional groups. The mean age was 48.9+/-19.0 and 48.2+/-19.7 in the respective groups (p=0.66). The PHN interacted with the cases in the intervention group by initial face to face interview and telephone calls an average of 7.1+/-9.2 times during the initial six months. The intervention group showed a significantly higher treatment success rate, 91.6%, (Rate Ratio [RR]; 1.23, 95% Confidence Interval [CI]; 1.12~1.36), lower default, 3.6%, (RR; 0.31, 95% CI; 0.13~0.75) and transfer-out rate, 3.0%, (RR; 0.32, 95% CI; 0.12~0.86) than the conventional group where they were: 75.0%, 11.6%, 9.3%, respectively. The success rate was even higher than the rate (80.5%) of 1,027 cases treated in health centers (RR; 1.11, 95% CI; 1.05~1.17). Of the completed cases in the intervention group, 82.2% regarded the role of the public health nurse as very helpful. CONCLUSION: The treatment success rate, of tuberculosis patients in the private sector, was significantly improved by an intervention using a public-private collaboration model.
Cohort Studies ; Cooperative Behavior ; Health Education ; Hospitals, Private ; Humans ; Private Sector ; Prospective Studies ; Public Health Nursing ; Public Sector ; Telephone ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: IS6110 DNA fingerprint is a very useful tool for investigating the transmission of tuberculosis. The aim of this study was to identify the epidemiological situations within a given area (one province). METHODS: The 681 Mycbobacterium tuberculosis isolates from patients, who were registered at health centers in Gyeonggi Province from May to December in 2004, were subjected to IS6110 DNA fingerprinting. Patients belonging to clusters were interviewed by health-workers to determine their previous contacts or household TB history. RESULTS: The number of IS6110 copies of the 681 isolates showed diverse fingerprint patterns from 0 to 21 of which the most prevalent copy number was 10 from 120 isolates (17.6%). Thirty-three isolates (4.8%) belonged to the K strain, and 128 isolates (18.8%) belonged to the K family. There were 180 (26.4%) isolates belonged belonging to fifty clusters, of which two clusters were within household transmission. Forty-three (23.9%) out of 180 patients resided in an area under the same health center control. The rate of clusters in those aged 60-70 was higher than in any other age group ( 95% CI of RR : 1.072 ~ 1.988). CONCLUSION: This is the first report of an epidemiological survey based on a whole province using a DNA fingerprinting technique for M. tuberculosis. These results will be helpful in developing a program or policies to prevent the transmission of TB.
Dermatoglyphics ; DNA Fingerprinting* ; DNA* ; Epidemiology ; Family Characteristics ; Gyeonggi-do* ; Humans ; Mycobacterium tuberculosis* ; Mycobacterium* ; Tuberculosis

BACKGROUND: Recently the incidence of coronary artery disease has been increased rapidly in Korea. After the introduction of coronary care unit, the mortality rate of cardiovascular patients has been decreased. The predictive factors for mortality in patients admitted at Coronary Care Unit (CCU) are important in the management of acutely ill cardiovascular patients. METHODS: One thousand one hundred and thirty patients (64.8+/-14.5 years), who were admitted at CCU from January 2002 to June 2003, were analyzed. The patients were divided into two groups according to mortality: the survived group (Group I: n=1055, 63.3+/-13.3 years) and the moribund group (Group II: n=75, 64.8+/-14.1 years). Clinical characteristics, risk factors, clinical diagnosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups. RESULTS: The overall mortality at CCU was 6.6%, 75 out of 1130 patients. Age and sex were not different between both groups. Coronary artery disease was the most common cause of admission (886 out of 1130 patients) and death (46 out of 75 patients). Coronary angiographic findings were not different between the two groups. Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (53.1+/-15.6% vs. 42.3+/-16.3%, p<0.05). Predictive factors for mortality by multiple logistic regression analysis were low LVEF (OR 11.4, 2.9-21.4 95%CI, p<0.001), no performance of percutaneous coronary intervention (PCI, OR 10.8, 2.5-17.8 95%CI, p<0.001) and clinical diagnosis of aortic dissection (OR 3.8, 1.3-9.8 95%CI, p=0.021). CONCLUSIONS: The predictive factors for mortality at CCU were low LVEF, no PCI and aortic dissection.
Clinical Laboratory Techniques ; Coronary Artery Disease ; Coronary Care Units* ; Coronary Disease ; Diagnosis ; Echocardiography ; Humans ; Incidence ; Korea ; Logistic Models ; Mortality* ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors ; Stroke Volume

BACKGROUND AND OBJECTIVES: Little data exist relating to the mechanism of myocardial ischemia in patients with coronary artery ectasia (CAE). The purpose of this study was to evaluate the fractional flow reserve (FFR), as an index of myocardial ischemia, in patients with CAE. SUBJECTS AND METHODS: Ten patients (7 males, 54.0+/-12.6 years) who diagnosed as CAE, by coronary angiographies, between March 2002 and July 2002, were analyzed. The clinical diagnosis of all the patients was unstable angina. FFR were performed using a pressure wire on the patients diagnosed with slow flow CAE from their coronary angiograms. After measurement of the baseline FFR using adenosine 20 microgram for the right coronary artery, and 24 microgram for the left anterior descending artery, the changes in the FFR with 500 microgram of intracoronary nitrate and 2 mg of Nicorandil were observed. RESULTS: Smoking was the most frequently associated risk factor. Type I CAE, according to Markis' classification, was the most prevalent at 60.0%. The values of the baseline FFR in the left anterior descending artery and right coronary artery, following the intracoronary injection of adenosine were both normal, and there were no significant changes in the FFR following the intracoronary injections of nitrate and Nicoronadil. CONCLUSION: The value of the FFR with CAE was normal, and an intracoronary injection of vasodilators did not change the FFR in patients with CAE. Therefore, vasodilator therapy might be beneficial for patients with symptomatic CAE.
Adenosine ; Angina, Unstable ; Arteries ; Blood Flow Velocity ; Classification ; Coronary Angiography ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Dilatation, Pathologic* ; Humans ; Ischemia ; Male ; Myocardial Ischemia ; Nicorandil* ; Risk Factors ; Smoke ; Smoking ; Vasodilator Agents

BACKGROUND AND OBJECTIVES: Little data exist concerning the clinical outcome of patients with acute myocardial infarction (AMI) and angiographically normal coronary arteries (NCA). The purpose of this study was to evaluate the clinical outcome, the etiological factors and prognosis of these patients. SUBJECTS AND METHODS: The subjects were divided into two groups according to findings from coronary angiograms performed between January 1999 and December 2001, Group 1 : comprised of 46 patients, 34 males and 12 females, with a mean age of 50.4+/-11.9 years, had AMI with NCA ; Group II : 181 patients, 143 males and 38 females, with a mean age of 59.0+/-10.3 years, with AMI and total occlusion of the coronary arteries. RESULTS: The percentages of smoking and hypertension were similar between the two groups ; a higher prevalence rates of hyperlipidemia and diabetes were observed in group II compared to group I (p=0.03, 0.01). In group I, coronary spasm, combined inflammatory diseases and embolization were demonstrated in 32.6, 6.5 and 4.3% of subjects, respectively. The left ventricular ejection fraction was higher in group I than group II (51.5+/-11.3% vs. 46.2+/-10.5%, p=0.006). In-hospital outcomes, with the combined end-point defined as death, re-infarction and stroke was 0% in group I vs. 7.7% in group II (p=0.07). The mean long-term survival rate during the 26.5-month clinical follow-up were 100 and 92.2% in groups I and II (p=0.04), respectively. CONCLUSION: A coronary spasm is the most common cause of AMI with NCA, but these patients had the higher long-term clinical event-free survival.
Coronary Disease ; Coronary Vessels ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Myocardial Infarction* ; Prevalence ; Prognosis ; Smoke ; Smoking ; Spasm ; Stroke ; Stroke Volume ; Survival Rate

No abstract available.
Animals ; Calcium* ; Clonidine* ; Ganglia, Spinal* ; Rats* ; Spinal Nerve Roots* ; Tetracaine*

OBJECTIVES: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. METHODS: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. RESULTS: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9 +/- 17.3 years in AVNRT, 25.5 +/- 13.3 years in WPW and 26.3 +/- 15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6 +/- 23.9 per minute and AVRT was 186.7 +/- 38.0 per minute, which were faster than that of AVNRT(161.7 +/- 28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. CONCLUSION: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.
Catheter Ablation ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Korea ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinoatrial Nodal Reentry ; Tachycardia, Supraventricular* ; Tertiary Care Centers ; Wolff-Parkinson-White Syndrome

OBJECTIVE: Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). METHODS: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. RESULTS: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2+/-13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1+/-12.6 seconds and 63.3+/-14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2+/-13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2+/-41.7 seconds and 38.5+/-29.6 seconds for the first inflation and the second, respectively(P<0.05). CONCLUSION: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Animals ; Coronary Stenosis ; Electrocardiography* ; Heart ; Humans ; Hypertrophy ; Inflation, Economic ; Ischemia ; Ischemic Preconditioning ; Myocardial Infarction ; Myocardial Ischemia ; Reperfusion