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

A report of a 79 year old male patient suffering from acute myocardial infarction with Mallory-Weiss tear after successful cardiopulmonary resuscitation(CPR) by emergency medical technician in the swimming pool is presented. Successful percutaneous coronary intervention(PCI) was done after appropriate transfusion. The patient survived and discharged without major complications after admitting 11days in the hospital. Importance of CPR in AMI patient is reiterated as complication such as Mallory-Weiss tear may arise.
Cardiopulmonary Resuscitation* ; Emergency Medical Technicians ; Humans ; Male ; Mallory-Weiss Syndrome* ; Myocardial Infarction* ; Swimming Pools

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (family Bunyaviridae, genus Phlebovirus). A 77-year-old female farmer was bitten by a tick and developed a fever 5 days later, resulting in admittance to the emergency room. The laboratory findings showed elevated liver enzyme levels, thrombocytopenia, and leukopenia. Lymphoma was suspected based on computed tomography results. After confirming SFTS virus infection via the polymerase chain reaction, a bone marrow biopsy revealed hemophagocytic lymphohistiocytosis (HLH). HLH is rarely observed in patients with SFTS and few studies have reported the presence of SFTS in bone marrow. Here, we report a case of SFTS that was initially mistaken for a lymphoma, and was accompanied by HLH.
Aged ; Biopsy ; Bone Marrow ; Bunyaviridae ; Emergency Service, Hospital ; Farmers ; Female ; Fever* ; Humans ; Leukopenia ; Liver ; Lymphohistiocytosis, Hemophagocytic* ; Lymphoma ; Polymerase Chain Reaction ; Thrombocytopenia* ; Ticks

OBJECTIVES: The purpose of this study was to develop a self-administered questionnaire survey to determine its validity and reliability as well as to improve the instructions for measurement of periodontal disease during oral examination for reliably calculating the prevalence of periodontal disease. METHODS: The data obtained was analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model to evaluate validity and reliability of the instrument. RESULTS: We developed a self-administered questionnaire survey consisting of 14 questions based on NHANES. We confirmed the reliability by testing and re-testing the questionnaire survey using selfadministered methods. The average Kappa index obtained was 0.73, which indicated a relatively high reliability. CONCLUSIONS: Reliability and validity of the self-administered assessment tool for periodontal disease developed for the local situation/circumstances of Korea is suitable to be applied for oral examination of a large population. Moreover, the questionnaire survey for periodontal disease could be used to acquire data for constructing a database for oral health policy development.
Diagnosis, Oral ; Korea ; Nutrition Surveys ; Oral Health ; Periodontal Diseases* ; Policy Making ; Prevalence ; Surveys and Questionnaires* ; Reproducibility of Results*

Cystic lesions or progressive cystic changes in adenocarcinoma of the lung have rarely been reported. We report a case of lung adenocarcinoma that progressed from ground-glass opacities (GGOs) and consolidations or nodules to extensive cystic lesions during 12 months in a young adult patient. A 29-year-old male was initially diagnosed with primary lung adenocarcinoma by transbronchial lung biopsy of the right lower lobe and lung to lung metastasis in both lungs according to imaging findings. The initial chest computed tomography (CT) scans showed multifocal GGOs, consolidations, and nodules in both lungs. Despite treatment with palliative chemotherapy, the patient's follow-up CT scans showed multiple, cystic changes in both lungs and that the lesions had progressed more extensively. He died of hypoxic respiratory failure one year after his diagnosis.
Adenocarcinoma ; Adult ; Biopsy ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Male ; Neoplasm Metastasis ; Respiratory Insufficiency ; Thorax ; Young Adult

Aortopulmonary fistula is an uncommon but often fatal condition resulting as a late complication of an aortic aneurysm. The most common cause is erosion of a false aneurysm of the descending thoracic aorta into the pulmonary artery, resulting in the development of a left-to-right shunt and leading to acute pulmonary edema and right heart failure. We report an our experience with aortopulmonary fistula as a rare complication associated with thoracic aortic aneurysm and high output heart failure.
Aneurysm, False ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Arterio-Arterial Fistula ; Fistula ; Heart Failure ; Pulmonary Artery ; Pulmonary Edema

OBJECTIVE: The atypical antipsychotics are being increasingly used to control acute episode of bipolar disorder, and data are emerging to support their mood-stabilizing and antidepressant properties. This study investigated the short-term efficacy of quetiapine as a combination therapy in the treatment of acute bipolar I disorder. METHODS: This study was a 4-week, open-label, combination, prospective investigation using quetiapine in addition to mood stabilizers. Data of 18 patients fulfilling DSM-IV diagnostic criteria for bipolar I disorder were analyzed. The Young Mania Rating Scale (YMRS), the Hamilton Scale for Depression (HDRS), the Brief Psychiatric Rating Scale (BPRS) and the Extrapyramidal Symptom Rating Scale (ESRS) were applied at baseline and at week 1, 2 and 4. The Clinical Global Impression Scale (CGI) was evaluated at baseline and week 4. RESULTS: The addition of quetiapine produced a statistically significant improvement on the YMRS, HDRS, BPRS and CGI score at week 4 from baseline (p<0.01). Significant improvement on the ESRS-Parkinsonism subscore was observed at week 1, 2 and 4 from baseline (p<0.05). Quetiapine was well tolerated, with no subjects discontinuing because of side effects. CONCLUSION: This study suggests that combination of quetiapine was an effective and safe treatment in patients with acute episode of bipolar disorder. Randomized placebo-controlled prospective studies with increased sample size are needed.
Antipsychotic Agents ; Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy ; Humans ; Prospective Studies ; Sample Size ; Quetiapine Fumarate

Little is known about processing mechanism of sensory input from the periodontal ligaments to the trigeminal motor nucleus for the control of chewing force and modulation of chewing pattern. Low threshold mechanoreceptive periodontal afferent was labeled with horseradish peroxidase by use of intra-axonal injection technique and investigated with electron microscopy. Quantitative ultrastructural analysis was performed on the 39 serially reconstructed labeled boutons in the trigeminal motor nucleus in cat. Labeled bouton contained clear spherical vesicles and one or two large dense cored vesicles. Most of labeled boutons were dome or round shape. All the analysed labeled boutons were presynaptic to dendritic shaft or distal dendrite and those presynaptic to soma or proximal dendrite were not observed. A large number of labeled boutons (46.2%) were postsynaptic to one or two presynaptic pleomorphic vesicle containing endings. Synaptic triad, in that a presynaptic ending which is presynaptic to the labeled bouton, in turn, is presynaptic to dendrite that is postsynaptic to the labeled bouton, was observed in 10.3% of the labeled boutons. Most of the labeled boutons showed simple synaptic organization, in that 64.1% of the labeled boutons made synaptic contacts with one or two neuronal profiles. One (2.6%) of the 39 analyzed labeled boutons showed synaptic contacts with 5 or more neuronal profiles. Labeled bouton volume, mitochondrial volume, apposed surface area and active zone area showed wide variation. These ultrastructural parameters were positively correlated with bouton volume. The values for apposed surface area and active zone area with presynaptic p-endings, in contrast to those with postsynaptic dendrites, showed narrow range and had little correlation with bouton volume. The present study revealed characteristic features on ultrastructural parameters of labeled boutons from periodontal afferent which is involved in periodontal masseteric reflex, and that influence on the postsynaptic trigeminal motoneurons showed wide variability.
Animals ; Carisoprodol ; Cats ; Dendrites ; Horseradish Peroxidase ; Mastication ; Microscopy, Electron ; Mitochondrial Size ; Neurons ; Periodontal Ligament ; Reflex ; Synapses

BACKGROUND AND OBJECTIVES: Late coronary in-stent restenosis remains an important clinical problem in coronary intervention. The effects of Paclitaxel (Taxol), an antimicrotubule agent, on neointimal proliferation within porcine coronary arteries were evaluated. METHOD: Stent overdilation injury was performed in porcine coronary arteries without local delivery of paclitaxel (n=10, Group I). Stent overdilation injury was also performed after local delivery of paclitaxel nanoparticle using the Dispatch Catheter(TM) in other coronary arteries (n=10, Group II). Coronary angiography and histopathologic examinations, which were performed 4 weeks after stenting, and complete blood counts and blood chemistry before and 4 weeks after the local delivery were compared. RESULT: 1) Reference vessel diameter, stented artery diameter, and diameter stenosis were not different between two groups. 2) Histopathologic injury score, external elastic lamina area, internal elastic lamina area, and luminal area were not different between two groups. 3) Neointimal area and histopathologic area stenosis were smaller significantly in the group II than in group I (2.3+/-0.33 vs 3.7+/-1.40 mm2, 22.2+/-19.26 vs 31.1+/-7.15%: p=0.04, 0.03, respectively). 3) Proliferating cell nuclear antigen index was lower in the stent overdilation injury with local paclitaxel delivery group than in the stent overdilation injury alone (31.10+/-3.70 vs 46.80+/-5.20%, p=0.04). 4) No significant laboratory changes were observed before and 4 weeks after the local delivery. CONCLUSION: Local delivery of paclitaxel nanoparticle inhibits neointima formation after stent overdilation injury in porcine coronary arteries without systemic toxicity.
Arteries ; Blood Cell Count ; Chemistry ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Nanoparticles* ; Neointima ; Paclitaxel* ; Phenobarbital ; Proliferating Cell Nuclear Antigen ; Stents*

BACKGROUND: Craniopharyngioma is a suprasellar or intrasellar epithelial neoplasm that occurs in both children and adults. It accounts for 1.2 to 3 % of intracranial tumors with an incidence of 0.5 to 2 cases per one million populations each year. Recently, it has been postulated that it may have two pathogenetically separate subtypes, which are adamantinous and papillary craniopharyngioma, and that their clinical features may be different. However, there are some disagreements in this postulation. Therefore, we studied 22 consecutive patients with craniopharyngioma to evaluate the differences in clinical features and MRI findings between two subtypes. METHODS: We studied 22 patients with histologically proven craniopharyngioma after surgery at Samsung Medical center from 1995 to 1999. Thirteen patients were male, and nine patients were female. The average age was 30 years, with a range from 1 to 58 years. We divided 22 patients into two histopathologically separate subtypes; adamantinous and papillary subtypes. We compared the clinical features and MRI findings of two subtypes by reviewing medical records. RESULTS: Out of 22 patients with craniopharyngioma, 19 patients had an adamantinous subtype and 3 patients had a papillary subtype. The adamantinous subtype occurred frequently in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype located in suprasellar or intrasellar portion as well as extrasellar portion, while the papillary subtype was restricted to the suprasellar location. The average tumor size of the adamantinous subtype was 3.7 cm, with a range from 1.4 to 6.0 cm, which was larger than that of the papillary subtype (average size 1.8 cm with a range from 1.5 to 2.3 cm, p< 0.05). The adamantinous subtype was predominantly cystic, while the papillary subtype was predominantly solid (p< 0.05). There were no significant differences in the preoperative clinical features and the postoperative complications between two subtypes. CONCLUSION: The adamantinous subtype had two peaks of occurrence in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype was larger and had cystic portion, while the papillary subtype was smaller and had solid portion. The preoperative clinical features and the postoperative complications between two subtypes seemed not to be different.
Adult ; Child ; Craniopharyngioma* ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Male ; Medical Records ; Neoplasms, Glandular and Epithelial ; Postoperative Complications