Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
Adult ; Aged ; Alcohol Drinking ; Ambulances ; Atrial Fibrillation ; Cerebral Hemorrhage ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Female ; Hemorrhage ; Hope ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Prevalence ; Reperfusion ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage ; Writing

Schwannoma in colorectum is a rare subepithelial polyp of mesenchymal origin, which is derived from the neural sheath, and most of reported cases were removed surgically. We, herein, describe two cases of schwannoma of the cecum, which were removed by endoscopic mucosal resection. A 34-year-old man and a 62-year-old man presented with abdominal discomfort and bowel habit change. The patients were diagnosed with a subepithelial tumor in the cecum on colonoscopy and underwent endoscopic mucosal resection under a tentative impression as neuroendocrine tumor, such as carcinoid tumor. Histopathology and immunohistochemistry confirmed the colonic lesion to be a benign schwannoma.
Carcinoid Tumor ; Cecum ; Colon ; Colonoscopy ; Humans ; Immunohistochemistry ; Neurilemmoma ; Neuroendocrine Tumors ; Polyps

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world and is the only major disease that is continuing to increase in both prevalence and mortality. The second Korean National Health and Nutrition Survey revealed that the prevalence of COPD in Korean subjects aged > or =45 years was 17.2% in 2001. Further surveys on the prevalence of COPD were not available until 2007. Here, we report the prevalence of spirometrically detected COPD in Korea, using data from the fourth Korean National Health and Nutrition Survey (KNHANES IV) which was conducted in 2007~2009. METHODS: Based on the Korean Statistical Office census that used nationwide stratified random sampling, 10,523 subjects aged > or =40 years underwent spirometry. Place of residence, levels of education, income, and smoking status, as well as other results from a COPD survey questionnaire were also assessed. RESULTS: The prevalence of COPD (defined as forced expiratory volume in 1 sec/forced vital capacity <0.7 in subjects aged > or =40 years) was 12.9% (men, 18.7%; women, 7.5%). In total, 96.5% of patients with COPD had mild-to-moderate disease; only 2.5% had been diagnosed by physicians, and only 1.7% had been treated. The independent risk factors for COPD were smoking, advanced age, and male gender. CONCLUSION: The prevalence of COPD was 12.9% in the KNHANES IV data. Most patients with COPD were undiagnosed and untreated. Based on these results, a strategy for early COPD intervention is warranted in high risk subjects.
Aged ; Censuses ; Female ; Forced Expiratory Volume ; Humans ; Hypogonadism ; Korea ; Male ; Mitochondrial Diseases ; Nutrition Surveys ; Ophthalmoplegia ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking ; Spirometry ; Vital Capacity

PURPOSE: Immunosuppressive regimen based on reduced-dose Tacrolimus (TAC) is widely accepted in the field of renal transplantation. However, optimal targetsfor TAC whole blood trough concentrations during the early period after kidney transplantation remain uncertain. METHODS: A total of 184 consecutive adult renal transplant recipients with triple immunosuppression (TAC/Mycophenolate/corticosteroid) were included in this study. According to the trough level of TAC at day 7 after transplantation, patients were classified as low TAC concentration (LT, <10 ng/ml, n=85), intermediate TAC concentration (IT, 10~15 ng/ml, n=75), and high TAC concentration (HT, >15 ng/ml, n=24) groups. Rate of acute rejection, graft function and side effects of TAC within 1 yr after transplantation were evaluated. RESULTS: There was no difference in trough concentrations of TAC at 2 weeks, 1 month, 3 months, 6 months and 12 months after transplantation among the three groups. Significantly higher incidence of acute rejection within 2 weeks after transplantation was observed in LT group compared with IT and HT groups (17.4%, 5.6% and 4.8%, respectively, P=0.037). HT patients showed significantly better estimated glomerular filtration rates until 6 months after transplantation than IT and LT patients (75.5+/-24.8 vs. 63.8+/-12.8 and 64.3+/-15.2 ml/min at 6 months, P=0.03). There was no significant difference in TAC toxicity in terms of post-transplant diabetes and renal toxicity. CONCLUSION: Short-term high TAC exposure immediately after kidney transplantation may provide lower incidence of acute rejection and better restoration of graft function compared with low or intermediate TAC exposure.
Adult ; Glomerular Filtration Rate ; Graft Rejection ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation ; Rejection (Psychology) ; Tacrolimus ; Transplants

PURPOSE: In complicated diverticular disease, hand-assisted laparoscopic surgery (HALS) has been considered as a useful alternative treatment to standard laparoscopic surgery (SLS) and open surgery. As compared with standard laparoscopic surgery, HALS offers advantages such as tactile sense, better exposure, and shorter learning curve. Minimally invasive surgery is another advantage of HALS. The aim of this study was to compare SLS to HALS in patients with diverticular diseases of the small bowel and the colon. METHODS: We retrospectively reviewed the records of 32 patients who had undergone SLS and HALS for diverticular disease between February 2002 and March 2009. RESULTS: Of the 32 patients, 20 patients (62.5%) were in the SLS group, and 12 patients (37.5%) were in the HALS group. The mean maximal incision length was longer in the HALS group (SLS group vs. HALS group, 4.5 vs. 7.4 cm, P<0.001). However, the mean operating time, the time to flatus, the time to diet, the mean duration of narcotic analgesia, the length of hospital stay, and the postoperative complications were similar. There was no mortality in either group. CONCLUSION: The longest incision length for the HALS group was longer than that for the SLS group, but HALS could reduce the conversion rate and has the many advantages of minimally invasive surgery. For complicated diverticular disease, HALS may be considered as a useful alternative treatment.
Analgesia ; Colon ; Diet ; Flatulence ; Hand-Assisted Laparoscopy ; Humans ; Imidazoles ; Laparoscopy ; Learning Curve ; Length of Stay ; Nitro Compounds ; Postoperative Complications ; Retrospective Studies

Gastric mucosal calcinosis (GMC) is a very rare condition that is characterized by the nodular deposition of calcium salts in the gastric mucosa. It has been associated with renal failure, gastric cancer, ingestion of aluminum- containing antacids and the use of sucralfate in organ transplant patients. The etiology of this condition is uncertain, but several theories have been proposed; the condition is due secondarily to hyperparathyroidism in renal failure and to the alkalinization of the gastric mucosa. We report here on two patients who had long-term use of bismuth and/or aluminum-containing antacids to treat their gastro-esophageal reflux symptoms. The esophagogastroduodenoscopy revealed acute gastritis patterns, and GMC was confirmed histologically with biopsy. When one patient stopped ingesting bismuth-containing antacid solution, the follow-up esophagogastroduodenoscopy and the biopsy revealed a completely improved state. We report here on these interesting cases and we include a brief review of the literature.
Antacids ; Biopsy ; Bismuth ; Calcinosis* ; Calcium ; Eating ; Endoscopy, Digestive System ; Follow-Up Studies ; Gastric Mucosa ; Gastritis ; Gastroesophageal Reflux ; Humans ; Hyperparathyroidism ; Renal Insufficiency ; Salts ; Stomach Neoplasms ; Sucralfate ; Transplants

Purpose: Kidney transplantation (KT) is one of the important treatment modality for the patients with focal segmental glomerulosclerosis (FSGS), but high recurrence rate and resulting graft failure is still a great obstacle. In order to compare the results of transplantation for recipient with FSGS, we reviewed our cases retrospectively. Methods: Thirty-six biopsy proven FSGS were reviewed and compared their clinical characteristics according to their recurrence status, retrospectively. Patient with significant proteinuria after KT was re-biopsied and light- and electron-microscopic study were done to confirm the recurrence of original disease. Results: Recurrence of FSGS was confirmed histologically in 13 (36%) recipients. Among 15 failed grafts, 9 grafts lost their function by recurrence of FSGS. Higher rate of acute rejection associated in recurred group (53% vs 39%). Five-year graft survival of recurred group was significantly lower than non-recurred group (65% vs 78%, P=0.0071). Cyclosporin group showed more frequent recurrence of FSGS after transplantation than tacrolimus group but no statistical significance (P>0.05). Plasmapheresis (PP) was done in 8 patients with early recurred FSGS and was effective in reducing the grade of proteinuria. Their long-term graft survival, however, was poor even though half of the recurred patients maintain their graft function until 5 years after PP. Conclusion: Our data showed that the recurred FSGS group showed higher rate of graft loss and poor graft survival. Since the FSGS recurrence is directly related with graft survival, large data analysis will be necessary to analyze the risk factor of recurrence and prevent adverse effect of recurrence of FSGS after KT.
Biopsy ; Cyclosporine ; Glomerulosclerosis, Focal Segmental* ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Plasmapheresis ; Proteinuria ; Recurrence ; Retrospective Studies ; Risk Factors ; Statistics as Topic ; Tacrolimus ; Transplants

OBJECTIVE: To evaluate the incidence of the +769 G/A mutation of inhibin-alpha gene in Korean patients with idiopathic premature ovarian failure. DESIGN: DNA analysis of the mutation. METHODS: One hundred patients with idiopathic premature ovarian failure (POF) were recruited. Patient with known causes of premature ovarian failure were excluded: cytogenetic abnormalities, prior chemotherapy, prior bilateral oophorectomy and autoimmune disease, etc. DNA was extracted from peripheral blood and the +769 G/A variant of Inhibin-alpha gene (INH-alpha) was analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism using restriction enzyme BbvI. RESULTS: We didn't find any case of +769 G/A variant in Inhibin-alpha gene in 100 Korean patients with idiopathic POF. CONCLUSION: This result suggests that in contrary to the recent data reported on the Asian population, the +769 G/A variant in inhibin-alpha gene may not exist in Korean patients with idiopathic POF.
Asian Continental Ancestry Group ; Autoimmune Diseases ; Chromosome Aberrations ; DNA ; Drug Therapy ; Female ; Humans ; Incidence ; Ovariectomy ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Primary Ovarian Insufficiency*

PURPOSE: To analyze the rate of allograft contamination from living donors using a swab culture method and to determine the necessity of antibacterial processing. MATERIALS AND METHODS: From September 2001 to June 2004, 334 allografts were obtained from living donors undergoing total joint arthroplasty. Two hundred and fourteen allografts were obtained from the femoral heads, 86 from the knee joint, and 34 from other sources. All allografts from donors with inflammatory diseases were discarded. After retrieving the graft, the entire surface of the allograft was carefully swabbed, and the specimen was inoculated and cultured on blood agar for 48 hours. A bacterial culture with the entire tissue was also carried out on discarded allografts, and the rate of contamination was compared with that of used allografts. RESULTS: Of the 334 allografts, 20 (6%) allografts were culture positive using swab method. 132 allografts were discarded. The reasons for discarding were a prior medical history in 26, no informed consent in 54 and a positive blood test in 10. The rate of contamination of the discarded allografts was 15% (20/132) using the swab method, and 19% (25/132) using entire tissue culture method. The sensitivity of the swab culture technique was only 44%. CONCLUSION: The low sensitivity implies that the swab method is unsuitable for detecting bacterial contamination. Unprocessed swab-culture-negative grafts may be contaminated with organisms that can cause infections. Therefore, additional antibiotic processing such as gamma-irradiation will be required.
Agar ; Allografts* ; Arthroplasty ; Culture Techniques ; Head ; Hematologic Tests ; Humans ; Informed Consent ; Joints ; Knee Joint ; Living Donors* ; Tissue Banks ; Tissue Donors ; Transplants

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.
Back Pain ; Constriction, Pathologic ; Decompression ; Fractures, Compression* ; Humans ; Kyphoplasty ; Laminectomy ; Postoperative Period ; Retrospective Studies ; Spinal Stenosis* ; Vertebroplasty