BACKGROUND AND PURPOSE: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes ( < 21, < 31, and < 51 mL) were very high (all about >90%). CONCLUSIONS: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.
Atherosclerosis ; Cerebral Infarction ; Decision Making ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction ; Medical Staff, Hospital ; Methods ; Middle Cerebral Artery ; Sensitivity and Specificity ; Stroke ; Thrombectomy

BACKGROUND: Although skin cancer incidence has recently increased, there has been little research into the incidence, clinical manifestations, and prognosis of skin cancers in Korea, especially in Daegu City and the Kyungpook Province. OBJECTIVE: To analyze changes over the recent two decades in incidence and clinical patterns, including recurrence of skin cancers diagnosed at a university hospital in Daegu City. METHODS: We reviewed 1,566 skin cancer cases from 1994 to 2013 at the Department of Dermatology in Kyungpook National University Hospital (KNUH). We also divided them into first (1994~2003) and second group (2004~2013) to examine changes over the years. RESULTS: The average incidence of skin cancers among the total number of outpatients was 1.39% through whole study period including 0.38% in the first and 2.10% in the second decade. Basal cell carcinoma (BCC) was the most commonly diagnosed skin cancer (total:1st:2nd=0.60%:0.16%:0.91%), followed by squamous cell carcinoma (SCC) (0.43%:0.12%:0.65%) and malignant melanoma (MM) (0.22%:0.05%:0.34%). The most common skin cancer site was the face in each decade. The recurrence of three major skin cancers (BCC, SCC and MM) was diagnosed in 49 of the 1,402 patients (3.50%). In each disease, the recurrence rate (1st:2nd) was 1.64% (BCC, 4.11%:1.34%), 3.51% (SCC, 11.11%:2.55%), and 8.57% (MM, 4.35%:9.01%). CONCLUSION: This epidemiological study provided useful information about the incidence and prognosis of skin tumors in Korea, especially in Daegu City and Kyungpook Province.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Daegu* ; Dermatology ; Epidemiologic Studies ; Gyeongsangbuk-do* ; Humans ; Incidence ; Korea ; Melanoma ; Outpatients ; Prognosis ; Recurrence ; Skin ; Skin Neoplasms

Hypertensive encephalopathy and basal ganglia intracerebral hemorrhage (ICH) are a medical emergency caused by a sudden elevation of systemic blood pressure. Although the relationship between hypertensive encephalopathy and large ICH has not been clarified yet, Cushing reflex in acute elevations of ICP due to large ICH may induce or aggravate hypertensive encephalopathy. We report a rare case of isolated hypertensive brainstem encephalopathy combined with hypertensive ICH.
Basal Ganglia ; Blood Pressure ; Brain Stem* ; Cerebral Hemorrhage* ; Emergencies ; Hypertension ; Hypertensive Encephalopathy ; Magnetic Resonance Imaging ; Reflex

Edema ; Humans ; Lifting ; Maxillary Sinus ; Sinus Floor Augmentation ; Sinusitis ; Stress, Psychological ; Transplants

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.
Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Humans ; Myocardial Infarction

The published case series have suggested that appetite suppressants had some association with the development of stroke. Phendimetrazine is an appetite suppressant with sympathomimetic activity and it has a similar chemical structure with amphetamines. We report that a 22-year-old woman who had taken phendimetrazine for one month developed sudden right homonymous hemianopsia. MRI showed acute infarction in the territory of left posterior cerebral artery (PCA). Phendimetrazine should be considered as a cause of ischemic stroke.
Amphetamines ; Appetite Depressants ; Appetite* ; Female ; Hemianopsia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Posterior Cerebral Artery ; Stroke* ; Young Adult

BACKGROUND: Argatroban, a direct thrombin inhibitor, has been suggested to be beneficial in acute ischemic stroke by preventing microthrombi formation. The aim of this multicenter, aspirin-controlled, randomized trial is to determine the safety and the efficacy of argatroban compared with aspirin in acute ischemic stroke. METHODS: The patients within 48 hours of noncardioembolic ischemic stroke were recruited from 8 centers. Argatroban was infused continuously at 2.5 mg/hr for the first 48 h, and then 10mg of argatroban was infused over 3 h twice a day on days 3-7. Control group received aspirin 300 mg/day for 7 days. The primary outcome was the NIHSS at 30 days and the secondary outcome was Barthel index (BI) and modified Rankin scale (mRS) at 90 days. The safety was evaluated by the incidence of bleeding complication. RESULTS: A total of 236 patients (123 for argatroban and 113 for aspirin) were included. NIHSS at 30 days, BI at 90 days and mRS at 90 days did not show significant difference between the argatroban and the aspirin group (3.1 +/- 3.1 vs 3.5 +/- 3.0, 88.9 +/- 22.5 vs 86.2 +/- 23.8, 1.4 +/- 1.1 vs 1.6 +/- 1.3, p>0.3, respectively). Post hoc analysis revealed that as for the patients who were treated within 24 hours after onset, numbers of patients with NIHSS=1 at 30 days were larger in the argatroban group (23 of 49) than in the aspirin group (10 of 40) (p=0.03). Bleeding complication was not different between the two groups (2 of 123 vs 0 of 113: p>0.4). CONCLUSIONS: Argatroban treatment is relatively safe in acute ischemic stroke. The efficacy of argatroban is not superior to aspirin. However, argatroban may be more beneficial in some subgroup of stroke patients than aspirin.
Aspirin ; Hemorrhage ; Humans ; Incidence ; Stroke* ; Thrombin

Strongyloides stercoralis, which has two different generations: the free living and parasitic generation, is primarily adapted to warm climates, but strongyloidiasis has been reported sporadically in temperate and cold regions. Strongyloidiasis may be asymptomatic in almost 50 percent of the cases, rarely, infestation presents with severe clinical pictures. The reason for this exacerbation of illness is probably a rapid increase in the number of infecting larvas through the development or acceleration of a cycle of autoinfection. A breakdown of the host-parasite equilibrium due to decreased host resistance may occur in malnutrition, debilitating diseases or therapy with immunosuppressive drugs. Corticosteroid treatment may have an important role in the sudden occurrence of severe stongyloidiasis. We experienced a case of strongyloidiasis with severe malnutrition, accompanied with bronchial asthma and diabetes mellitus. This patient has been treated with corticosteroid for several years. So, we report this rare case with the literature review.
Acceleration ; Asthma ; Climate ; Diabetes Mellitus ; Family Characteristics ; Humans ; Larva ; Malnutrition* ; Strongyloides stercoralis ; Strongyloidiasis*

BACKGROUND: We performed the study on the changes of beta2-microglobulin(beta2M) clearance and urea reduction ratio after reuse of dialyzers with three different membranes. METHODS: 9 patients who had received regular hemodialysis more than five years were enrolled. Three kinds of dialyzer membrane were used; i.e. : Two of them were high-flux and the other was low-flux. Dialyzer reprocessing was performed by an automated machine using glutaraldehyde and bleach. Each dialyzer was reused 10 times. Solute clearance was determined for each dialyzer after the 1st, 5th, 8th and 10th reuse. RESULTS: Urea clearance was well maintained after reuse with both high-flux and low-flux membrane but beta2M clearance was significantly greater with high-flux dialyzers than low-flux dialyzer. Effects of each dialyzer reuse on beta2M clearance showed no significant decrease until the 10th reuse and no significant difference in beta2M clearance between the two high-flux dialyzers(polyamide vs PEPA membrane, p= 0.197). CONCLUSION: Reuse of dialyzers was cost-effective. After reuse of dialyzer, clearance of solute was maintained in both small and large solutes until the 10 th reuse. Further study is needed regarding the maintenance of solute clearance with increased number of reuses.
Blood Urea Nitrogen* ; Cellulose ; Glutaral ; Humans ; Membranes* ; Nylons ; Renal Dialysis ; Urea