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- 저자 : Cheolsu Jwa (검색결과 2 건)
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Kim, Taikwan,Jwa, Cheolsu The Korean Neurosurgical Society 2021 Journal of Korean neurosurgical society Vol.64 No.1
Objective : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.
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Yunsuk Choi,Moon Jong Un,Cheolsu Jwa 대한말초신경학회 2018 The Nerve Vol.4 No.1
A 51-year-old woman presented with visual disturbances that had persisted for approximately one year. She had been taking psychiatric medication for schizophrenia. Brain magnetic resonance imaging showed engorged vessels in both hemispheres, and a delay in the mean transit time and time to peak was observed on perfusion images. The initial transfemoral cerebral angiography showed multiple dural arteriovenous fistulas (AVFs) with cortical venous reflux and venous ectasia. Both middle meningeal arteries (MMAs), superficial temporal arteries (STAs), and occipital arteries (OAs) were feeding the fistulas, and the superior sagittal sinus was the draining vein. Owing to the presence of multiple lesions and feeder arteries, a staged treatment was planned. We first performed the Onyx embolization of the left MMA, followed by the surgical ligation of the left STA, with subsequent embolization of the left OA. Finally, the venous ectasia was clipped. Importantly, after treatment, the patient’s schizophrenia-like symptoms improved. The patient could be originally misdiagnosed with schizophrenia. This case shows that staged and active treatment should be considered in case of multiple dural AVFs for improvement of symptoms.
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