만성콩팥병이 급성 뇌경색 후 사망률에 미치는 영향

장일미,이경복,노학재,안무영 대한신경과학회 2009 대한신경과학회지 Vol.27 No.3

Background: Chronic kidney disease (CKD) is known to be associated with atherosclerosis and silent small-vessel occlusion, but there is scant information regarding the association between CKD and acute stroke. The aim of this study was to establish whether CKD influences the outcome and mortality rate after acute ischemic stroke. Methods: From January 2005 to June 2008, patients with CKD and with normal kidney function were identified from the entire population of patients presenting with acute ischemic strokes at Soonchunhyang university hospital. We analyzed the baseline demographics, risk factors, stroke severity, functional outcome, mortality rate, and the prognostic factors affecting mortality in the two groups, and investigated the causes of death. Results: Totals of 541 patients with normal kidney function (age 67.0±12.6 years; mean±SD) and 66 patients with CKD (age 70.8±11.9 years) were recruited. Hypertension and diabetes were more prevalent in the CKD group. National Institutes of Health Stroke Survey scores at admission (8.3±8.5 vs 5.5±6.0, p=0.001) and Modified Rankin Scale (mRS) scores at discharge (2.32±1.5 vs 1.92±1.5, p=0.067) were higher in the CKD group than in that with normal kidney function. Patients with CKD had a higher case-fatality rate (median survival time 13.9±13.6 months) than those without CKD (median survival time 19.2±13.2 months) and CKD was an independent prognostic factor for mortality after acute ischemic stroke. Cox proportional hazard analysis leukocytosis (hazard ratio, HR=4.46; 95% confidence interval, CI=1.28 –15.52), high cardioembolic risk (HR=7.68; 95% CI=1.59–37.08), and poor (mRS≥3) functional outcome at discharge (HR=8.67, 95% CI=2.19–34.33) were significant influencing factors on mortality in the CKD group. Conclusions: Compared with the normal kidney function condition, CKD is associated with a higher mortality after acute ischemic stroke. Leukocytosis, high cardioembolic risk, and poor functional outcome may be important prognostic factors of mortality from acute ischemic stroke with CKD. Background: Chronic kidney disease (CKD) is known to be associated with atherosclerosis and silent small-vessel occlusion, but there is scant information regarding the association between CKD and acute stroke. The aim of this study was to establish whether CKD influences the outcome and mortality rate after acute ischemic stroke. Methods: From January 2005 to June 2008, patients with CKD and with normal kidney function were identified from the entire population of patients presenting with acute ischemic strokes at Soonchunhyang university hospital. We analyzed the baseline demographics, risk factors, stroke severity, functional outcome, mortality rate, and the prognostic factors affecting mortality in the two groups, and investigated the causes of death. Results: Totals of 541 patients with normal kidney function (age 67.0±12.6 years; mean±SD) and 66 patients with CKD (age 70.8±11.9 years) were recruited. Hypertension and diabetes were more prevalent in the CKD group. National Institutes of Health Stroke Survey scores at admission (8.3±8.5 vs 5.5±6.0, p=0.001) and Modified Rankin Scale (mRS) scores at discharge (2.32±1.5 vs 1.92±1.5, p=0.067) were higher in the CKD group than in that with normal kidney function. Patients with CKD had a higher case-fatality rate (median survival time 13.9±13.6 months) than those without CKD (median survival time 19.2±13.2 months) and CKD was an independent prognostic factor for mortality after acute ischemic stroke. Cox proportional hazard analysis leukocytosis (hazard ratio, HR=4.46; 95% confidence interval, CI=1.28 –15.52), high cardioembolic risk (HR=7.68; 95% CI=1.59–37.08), and poor (mRS≥3) functional outcome at discharge (HR=8.67, 95% CI=2.19–34.33) were significant influencing factors on mortality in the CKD group. Conclusions: Compared with the normal kidney function condition, CKD is associated with a higher mortality after acute ischemic stroke. Leukocytosis, high cardioembolic risk, and poor functional outcome may be important prognostic factors of mortality from acute ischemic stroke with CKD.

지역 사회 노인의 치매와 경도인지장애 유병률과 위험 인자

장일미,이경복,노학재,안무영 대한치매학회 2014 Dementia and Neurocognitive Disorders Vol.13 No.4

Background: We investigated the prevalence of dementia and mild cognitive impairment (MCI) and their risk factors in an urban community-dwelling elderly people over 65 years old. Methods: A two-phase investigation was performed from January 2010 to December 2011. In Phase I, all subjects (n=9,485) responded to the Korean version of the Mini-Mental State Examination (K-MMSE). Based on the K-MMSE score the subjects were classified into two groups (‘Normal’ and ‘Cognitive decline’). In Phase II, cognitive decline subjects were diagnosed as dementia or MCI according to the neuropsychological tests and doctor’s interview. We also surveyed the socioeconomic and medical factors in Normal, Dementia and MCI groups. And we compared and analyzed the socioeconomic and medical risk factors by multiple logistic regressions in Dementia and MCI group. Results: The prevalence of dementia and MCI was obtained 5.4% and 4.3%, respectively. Old age, alcohol intake, living together, low economic status, jobless in the past, diabetes mellitus, previous stroke, lower BMI and family history of dementia were associated with the increased dementia risk. Higher education, hypertension and physical activity were associated with the decreased dementia risk. And old age, alcohol intake, higher education, previous stroke, lower BMI and physical activity were common risk factors in MCI group. Conclusions: The prevalence of dementia and MCI was obtained much lower than previous reports. Dementia and MCI patients had common socioeconomic and medical risk factors. It is also important to control the risk factors earlier to prevent the increase of patients in dementia. And in order to prove the hypothesis that early control of the risk factors can decrease the occurrence of dementia, the further prospective studies are needed.

반복 설하신경 자극검사로 진단한 중증근무력증 1예

장일미,이경복,노학재,안무영,양광익,성기범 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.1

Repetitive nerve stimulation is a simple and widely used technique to demonstrate neuromuscular transmission defect. A significant decremental response for repetitive hypoglossal nerve stimulation was obtained from the surface recordings in the tongue of a patient with dysarthria and dysphagia. Repetitive hypoglossal nerve stimulation test may be useful in diagnosis of myasthenia gravis with bulbar symptoms only. We utilized repetitive hypoglossal nerve stimulation with tongue recordings and diagnosed a case of myasthenia gravis.

The Characteristics of Capgras Syndrome in Patients Diagnosed as Probable Alzheimer Disease

장일미,노학재,안무영,양영순,나해리,김상윤 순천향대학교 순천향의학연구소 2011 Journal of Soonchunhyang Medical Science Vol.17 No.2

Objective: We assessed the characteristics of Capgras syndrome in patients diagnosed as probable Alzheimer disease, and compared the clinical and imaging findings with other previous reports. Methods: We obtained medical records of patients with Capgras syndrome diagnosed as probable Alzheimer disease in three hospitals from March 2009 to March 2010. The basic characteristics, neuropsychologic tests, brain imaging data were investigated. Results: The mean age of the patients was 74.7 years old and all of the patients experienced this syndrome in relation to a spouse. Brain magnetic resonance imaging showed mild-to-moderate global atrophy, variable hippocampal atrophy in this study. The Mini-Mental State Examination mean scores were 18.78 and clinical dementia rating scores were from 1 to 2. All of the patients took medicine of acetycholine esterase inhibitors and two patients recovered with antipsychotic medication. Five patients had showed continuous Capgras syndrome, at the last follow-up day, for a year. Conclusion: Capgras syndrome patients in this study who were diagnosed as probable Alzheimer disease showed similar results to the individuals from other reports. More study is needed to estimate the numbers and characteristics of patients with this syndrome.

주중과 주말에 순천향대학교 병원에 내원한 급성 뇌경색 환자의 비교 분석

장일미,이경복,오형근,박정호,노학재,안무영 순천향대학교 의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.1

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심방세동 환자에서의 예방적 항응고 치료율에 관한 조사

장일미,이경복,안무영 순천향대학교 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.1

Background: Atrial fibrillation is a common arrhythmia in old age and definite risk factor of ischemic stroke. An effective treatment of atrial fibrillation is important in the prevention of ischemic stroke. Methods: We analyzed the patients admitted in SOONCHUNHYANG University hospital for acute cardioembolic stroke from March 2005 to March 2008. Baseline demographics, National Institute of Health Stroke Scale (NIHSS) at admission and discharge, past medical history, and mortality were assessed by predetermined protocols. The patients who took medication regularly in the medical department in SOONCHUNHYANG University hospital before stroke onset were included. We searched medical records of all of the patients for anticoagulation medication and prothrombin time. Results: A total of 69 patients were recruited. There are no significant differences in demographic characteristics, NIHSS at admission and discharge, frequency of neurologic complications and concomitant morbidities between the total cardioembolic patients and the patients who were followed up in our outpatient clinic. The rate of anticoagulation for the prevention of ischemic stroke in the patients with atrial fibrillation was lower than 10%. Conclusions: Our study shows that potentiation of anticoagulation therapy for the prevention of ischemic stroke should be necessary in the patients with atrial fibrillation.

병원내 발생 허혈성 뇌졸중의 치료 지연과 임상적 특징

장일미,김도의,김지선,이경복,노학재,안무영 순천향대학교 의학연구소 2009 Journal of Soonchunhyang Medical Science Vol.14 No.3

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바이러스성 심근염 환자에서 발현한 다발성 뇌경색 1예

장일미 대한뇌졸중학회 2008 Journal of stroke Vol.10 No.1

Although non-ischemic diseases of the myocardium are commonly complicated by cerebral embolism, those are mostly asso-ciated with chronic dilated cardiomyopathy or combined with endocardiopathy. Viral myocarditis is usually benign, and despite the sudden of myocardial infarct-like symptom, most patients improved significantly or recovered fully. We report an extre-mely rare case of a young woman with multiple cerebral infarctions in the course of viral myocarditis. (Korean J Stroke 2008; 10:55-57)

순천향대학 병원에 내원한 허혈성 뇌경색 환자의 남녀 비교 분석

김재하,장일미,이경복,오형근,박정호,노학재,안무영 순천향의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.1

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강한 손바닥 압박 후 속발된 엄지두덩운동신경병증 1예

이정곤,장일미,이경복,노학재,안무영 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Thenar motor neuropathy (TMN) is a compressive mononeuropathy of recurrent motor branch of median nerve. It is infrequent and may have different pathogenesis. It may be a unique entity of disease or considered a variant of carpal tunnel syndrome involving the motor branch only. We report a case of TMN induced by vigorous massage that applied strong digital pressure in the region of the base of palm and thenar muscles.