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( Agus Terawan Putranto ),( Tugas Ratmono ),( Andri Hidayat ),( Bayu Putera ),( Joko Widodo ),( Lucia Hermiwati ),( Mulyana Mulyana ),( Grace Chandra ),( Gatot S Lawrence Lao ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Background: Indonesian Basic Health Research Study (RISKESDAS) indicate that prevalence of stroke is 12.1%; and is considered as one of the major cause of death in Indonesia. It has been reported that ischemic stroke shown about 80-85% of the total cases. Conventional ischemic stroke management has indicated some major obstacles in the stroke management program; therefore an approach using intra-arterial heparin fi ushing method has been used to overcome the above limitations. Controversy has been around for sometimes, therefore 2 groups of scientifi c forum have been established InaCVF (Indonesia CerebroVascular Forum) and InaDOCAR Prevent (Indonesia DOCAR Prevent) to fi nd out the scientifi c rational in the management of ischemic stroke using intra-arterial heparin fi ushing. The objective of this approach is for recovering the cerebral blood perfusion at the optimal time. Methods: March 2013 - March 2014, there has been 4380 cases of ischemic stroke, and only 2146 (48.9%) undergone intra-arterial heparin fi ushing guided with digital subtracted angiography (3D-DSA). Prior to the heparin-fi ushing procedure, all patients are undergone functional MRI test and the patients are carefully selected for the optimal result. Post procedure, the patients undergone functional MRI. The pre and post functional MRI results are compared to determine the change of cerebral blood perfusion. Results: Of 2146 ischemic stroke patients, undergone intra-arterial heparin fi ushing, none of the patients had severe complication. Sixty-six percent, 32%, and 2% have signifi cant moderate and little improvement respectively. Further biochemical parameters is still under investigation to elucidate the pathomechanism. Conclusions: Intra-arterial heparin fi ushing in patient with ischemic stroke is a promising and effective modality.
( Tugas Ratmono ),( Terawan A Putranto ),( Andri Hidayat ),( Bayu Putera ),( Joko Widodo ),( Lucia Hermiwati ),( Mulyana Mulyana ),( Gatot S Lawrence Lao ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Background: Indonesian Basic Health Research Study (RISKESDAS) indicate that prevalence of stroke is 12.1%; and is considered as one of the major cause of death in Indonesia. It has been reported that ischemic stroke shown about 80-85% of the total cases, that continues to be the leading cause of long term disability worldwide. Primarily due to a loss of motor abilities and subsequent impairment in activities of daily living. Transcranial magnetic stimulation (TMS) is a non invasive tool that has been used in addition to other existing diagnostic tools to investigate motor pathophysiology in stroke patients. It has been shown to quantify the corticomotor excitability properties of clinically affected and unaffected muscles. Therefore, the objective of the study is to determine the usefulness of the device to rehabilitate the motoric function of the post-ischemic stroke patients Methods: March 2013 - March 2014, there has been 4380 cases of ischemic stroke, and only 2146 (48.9%) undergone intra-arterial heparin fl ushing guided with digital subtracted angiography (3D-DSA). Prior and post heparin-fl ushing procedure, all patients are undergone functional MRI test and assessment of the motoric function using TMS to examine the resting motor threshold (RMT), the amplitude (A), the latency (L), as well as Central Motoric conduction Time (CMCT) at the lesion and non lesion areas. Results: 2146 ischemic stroke patients, the RMT are 55.60±11.75 to 54.40±8.93 (p=0.52), and 52.78±10.59 to 52.22±8.59 (p=0.794); Amplitude are 1.57±1.76 to 1.7±1.72 (p=0.44), and 1.21±1.36 to 1.8±1.67 (p=0.005); Latency 23.76±4.51 to 23.51±4.36 (p=0.555) and 22.85±3.37 to 22.45±3.95 (p=0.104); and RMT 9.69±3.36 to 9.20±3.78 (p=0.238) and 8.87±2.92 to 8.02±2.58 (p=0.002) at the non lesion and lesion areas respectively. Conclusions: TMS provide a convincing evidence as new modality for post stroke rehabilitation.