76
|
Lee SH, Heo SH, Kim JH, Lee D, Lee JS, Kim YS, Kim HY, Koh SH, Chang DI. Effects of uric acid levels on outcome in severe ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator. Eur Neurol 2013; 71:132-9. [PMID: 24356095 DOI: 10.1159/000355020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
Abstract
Uric acid (UA) has been known to be a neuroprotective antioxidant because of its free radical scavenger activity. We studied the influence of UA in patients with acute ischemic stroke after thrombolytic therapy. Two hundred eighteen consecutive patients treated with intravenous thrombolysis were included in this analysis. We analyzed the relationship between serum UA levels obtained at the emergency department and clinical outcomes. Early improvement and excellent functional outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS) 24 h after onset and the modified Rankin scale after 3 months. There was no significant relationship between serum UA levels and early improvement or excellent functional outcome in the total patients (p = 0.583 and p = 0.082, respectively). However, in patients with severe baseline stroke deficits (NIHSS score ≥15), higher-tertile UA levels were significantly associated with excellent functional outcomes (p = 0.003). Excellent functional outcomes in patients with severe baseline disability might have a significant association with serum UA levels particularly in men but not in women (p = 0.007 in men and p = 0.621 in women). Increased serum UA levels might be associated with better outcomes in ischemic stroke patients treated with intravenous thrombolysis, but the effectiveness of UA can differ by initial stroke severity and gender.
Collapse
|
77
|
Kim YS, Lim SH, Oh KW, Kim JY, Koh SH, Kim J, Heo SH, Chang DI, Lee YJ, Kim HY. The advantage of high-resolution MRI in evaluating basilar plaques: A comparison study with MRA. Atherosclerosis 2012; 224:411-6. [PMID: 22920240 DOI: 10.1016/j.atherosclerosis.2012.07.037] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/18/2012] [Accepted: 07/24/2012] [Indexed: 11/27/2022]
|
78
|
Kim YS, Chung DI, Choi H, Baek W, Kim HY, Heo SH, Chang DI, Na HR, Kim SH, Koh SH. Fantasies about stem cell therapy in chronic ischemic stroke patients. Stem Cells Dev 2012; 22:31-6. [PMID: 22784218 DOI: 10.1089/scd.2012.0330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Stem cell therapy (SCT) has been proposed for the treatment of neurological disorders. Although there is insufficient clinical evidence to support its efficacy, unproven SCTs are being performed worldwide. In this study, we investigated the perspectives and expectations of chronic ischemic stroke patients and physicians about SCTs. A total of 250 chronic ischemic stroke patients were interviewed at 4 hospitals. Structured open and closed questions about SCT for chronic stroke were asked by trained interviewers using the conventional in-person method. In addition, 250 stroke-related physicians were randomly interviewed via an e-mail questionnaire. Of the 250 patients (mean 63 years, 70% male), 121 (46%) responded that they wanted to receive SCT in spite of its unknown side effects. Around 60% of the patients anticipated physical, emotional, and psychological improvement after SCT, and 158 (63%) believed that SCT might prevent strokes. However, physicians had much lower expectations about the effectiveness of SCTs, which was not in line with patient expectations. Multivariate analysis revealed that the male gender [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.10-3.64], longer disease duration (OR: 1.01, 95% CI: 1.00-1.02), higher modified Rankin Scale score (OR: 1.30, 95% CI: 1.06-1.60), and familiarity with stem cells (OR: 1.86, 95% CI: 1.10-3.15) were independently associated with wanting SCT. The major source of information about SCT was television (68%), and the most reliable source was physicians (49%). Patients have unfounded expectations that SCT will improve their functioning. Considering our finding that the major source of information on stem cells is media channels, but not the physician, to decrease patients' inappropriate exposure, doctors should make more effort to educate patients using mass media with accurate information.
Collapse
|
79
|
Hwang KJ, Heo SH, Chang DI. Multiple microembolic brain infarctions in Clonorchis sinensis infestation. J Neurol Sci 2012; 319:133-4. [DOI: 10.1016/j.jns.2012.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 11/26/2022]
|
80
|
Heo SH, Lee KH, Kim JW, Jeong YY. Unusual manifestation of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis of the uterus: emphasis on MRI and positron emission tomography CT findings. Br J Radiol 2011; 84:e210-2. [PMID: 22011824 DOI: 10.1259/bjr/24318075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There are several reports of adenocarcinoma developing within adenomyosis of the uterus, but imaging features of MRI, including diffusion-weighted imaging (DWI) and positron emission tomography (PET)-CT, have not been published. Herein we report a rare case of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis to emphasise the unusual growth features, as well as the imaging findings of the tumour on MRI and PET-CT.
Collapse
|
81
|
Lee D, Heo SH, Kim EJ, Chang DI. Pseudo-occlusion of the extracranial carotid artery caused by intracranial carotid artery stenosis. Neurol Sci 2011; 33:1201-3. [PMID: 22134755 DOI: 10.1007/s10072-011-0870-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/18/2011] [Indexed: 11/29/2022]
|
82
|
Heo SH, Cho CH, Kim HO, Jo YH, Yoon KS, Lee JH, Park JC, Park KC, Ahn TB, Chung KC, Yoon SS, Chang DI. Plaque rupture is a determinant of vascular events in carotid artery atherosclerotic disease: involvement of matrix metalloproteinases 2 and 9. J Clin Neurol 2011; 7:69-76. [PMID: 21779294 PMCID: PMC3131541 DOI: 10.3988/jcn.2011.7.2.69] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 12/20/2010] [Accepted: 12/20/2010] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Unstable carotid atherosclerotic plaques are characterized by cap rupture, leading to thromboembolism and stroke. Matrix metalloproteinases (MMPs) have been implicated in the progression of atherosclerosis and plaque rupture. The aim of this study was to assess the relationship between the expressions of MMP-2 and MMP-9 and carotid plaque instability. METHODS Eighty atherosclerotic plaques were collected from 74 patients undergoing carotid endarterectomy. Clinical information was obtained from each patient, and plaque morphology was examined at the macroscopic and microscopic levels. The immunohistochemical expressions of MMPs were graded using semiquantitative scales. RESULTS Macroscopic ulceration (84.6% versus 63.4%, p=0.042) and microscopic cap rupture (79.5% versus 51.2%, p=0.010) were more common in symptomatic than in asymptomatic patients. Immunoreactivities of MMP-2 and MMP-9 were increased in 40 and 36 atheromatous plaques, respectively. Macroscopic ulceration was strongly correlated with the expressions of MMP-2 (p<0.001) and MMP-9 (p=0.001). There were significant correlations between increased MMP-2 expression and cap rupture (p=0.002), intraplaque hemorrhage (p=0.039), and a thin fibrous cap (p=0.002), and between increased MMP-9 expression and cap rupture (p=0.010) and a large lipid core (p=0.013). CONCLUSIONS Plaque rupture was significantly associated with the development of vascular events in carotid atherosclerotic disease. MMP-2 and MMP-9 are strongly correlated with plaque instability.
Collapse
|
83
|
Jeong MG, Kim Y, Kim YJ, Oh MS, Yu KH, Lee BC, Lee JH, Kwon JH, Kwon SU, Heo SH, Choi JC, Kwon HM, Park JM, Kim EG, Rha JH, Park HK, Bae HJ, Han MK, Hong KS, Cho YJ, Park MS, Cho KH, Kim HY, Lee J, Kim DE, Lee SJ, Lee KB, Park TH, Cha MJ, Heo JH, Nam HS, Cha JK, Kim CH, Yoon BW. The Factors Associated with the Decision of r-tPA Use in Acute Ischemic Stroke Patients Aged 80 Years or Older. ACTA ACUST UNITED AC 2011. [DOI: 10.5853/kjs.2011.13.2.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
84
|
Kang WD, Heo SH, Choi YD, Choi HS, Kim SM. Alveolar soft part sarcoma of the uterine cervix in a woman presenting with postmenopausal bleeding: a case report and literature review. EUR J GYNAECOL ONCOL 2011; 32:359-361. [PMID: 21797137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Alveolar soft part sarcoma (ASPS) of the uterine cervix is a rare mesenchymal malignancy that occurs in adolescents and young adults. CASE REPORT A 52-year-old postmenopausal woman presented with profuse vaginal bleeding of one month's duration with severe anemia. The pelvic examination revealed a 3 cm mass on the posterior lip of the uterine cervix. On magnetic resonance imaging, the tumor had high signal intensity on T1- and T2-weighted images. A modified radical hysterectomy and bilateral salpingo-oophorectomy were performed. Immunohistochemical staining for TFE3 and electron microscopic examination revealed an ASPS of the uterine cervix. DISCUSSION The better prognosis of cervical ASPS, compared to the soft counterparts, may be related to early clinical detection, small size, resectability, and demarcation of the tumor.
Collapse
|
85
|
Han KS, Heo SH, Lee SJ, Jeon SH, Yoo KH. Comparison of urodynamics between ischemic and hemorrhagic stroke patients; can we suggest the category of urinary dysfunction in patients with cerebrovascular accident according to type of stroke? Neurourol Urodyn 2010; 29:387-90. [PMID: 19229954 DOI: 10.1002/nau.20708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS The aim of this study is to compare the urodynamic parameters in ischemic and hemorrhagic stroke patients with bladder dysfunction. MATERIALS AND METHODS We retrospectively reviewed medical records such as computed tomography (CT) or magnetic resonance imaging (MRI) and urodynamic study and identified 84 cases among 150 stroke patients underwent urodynamic test due to lower urinary tract symptoms (LUTS) from June 2003 to May 2008. Exclusion criteria are diabetes mellitus (DM) cystopathy, previous pelvic surgery, spinal cord injury, benign prostate hyperplasia (BPH), and other neurologic etiology. RESULTS Among analyzed variables of urodynamic study, total bladder capacity, postvoid residual urine volume and bladder compliance have a significant value between ischemic and hemorrhagic stroke group (P = 0.004, P = 0.017, P = 0.007). Ischemic group have detrusor overactivity (DO) (70.7%), detrusor underactivity (DU) (29.3%), and hemorrhagic group have DO (34.6%), DU (65.4%). (P = 0.003). CONCLUSIONS Evaluation of the stroke type may be helpful in the determination of the type of urinary dysfunction and in deciding the appropriate bladder management. The urodynamic study, however, is essential to manage LUTS in stroke patients.
Collapse
|
86
|
Heo SH, Lee SH, Kim BJ, Kang BS, Yoon BW. Does glycated hemoglobin have clinical significance in ischemic stroke patients? Clin Neurol Neurosurg 2009; 112:98-102. [PMID: 19766387 DOI: 10.1016/j.clineuro.2009.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 08/10/2009] [Accepted: 08/24/2009] [Indexed: 01/01/2023]
Abstract
OBJECTIVES It has been suggested that patients with an elevated hemoglobin A1c (HbA1c) level have an increased risk of cardiovascular disease regardless of the presence of diabetes. However, an association between HbA1c and stroke has not yet been determined. In this study, our purpose was to examine whether HbA1c was independently associated with various types of cerebral vascular lesions in stroke patients. METHODS A consecutive series of acute ischemic stroke patients were included for this analysis from October, 2002, to March, 2006. HbA1c was examined on admission, and MR imaging was performed for analysis of large artery diseases (LADs) and small artery diseases (SADs). Symptomatic or asymptomatic LAD was diagnosed by MR angiography, and SAD was classified as leukoaraiosis, microbleeds, or old lacunar infarctions. RESULTS A total of 639 stroke patients were analyzed (diabetics, n=247; non-diabetics, n=392). There was no relationship between the level of HbA1c and any type of cerebrovascular lesion in the non-diabetic patients. In contrast, HbA1c showed a significant negative association with symptomatic LAD and leukoaraiosis in the diabetic patients using univariate analysis (p=0.01 and p<0.05, respectively). These associations did not remain significant, however, after adjustment for age and hypertension. This was, in part, because the HbA1c level in our diabetic population decreased gradually with age (p=0.03). CONCLUSIONS Our results indicate that HbA1c is not associated with risk for various types of cerebrovascular lesions in ischemic stroke patients. The negative association between age and HbA1c in diabetic patients should be further investigated.
Collapse
|
87
|
Heo SH, Chang DI. Antithrombotic and Neuroprotective Therapy in Acute Ischemic Stroke. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.4.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
88
|
Heo SH, Lee MS, Ahn TB, Park KC, Yoon SS, Chang DI, Chung KC. A case of unilateral hemispheric encephalitis. Neurol Sci 2007; 28:185-7. [PMID: 17690849 DOI: 10.1007/s10072-007-0818-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 06/21/2007] [Indexed: 10/23/2022]
Abstract
Herein we report a case of encephalitis involving the unilateral hemisphere, with a clinical course different from that of Rasmussen syndrome. A 44-year-old man visited us because of headache and language abnormality. Cerebrospinal fluid examination showed lymphocytosis with increased level of protein. Brain MRI showed abnormal findings limited to the unilateral hemisphere. The symptoms and signs improved without any specific antiviral treatment in a week. However, language disturbance and right hemiparesis developed after a week. Steroid therapy was effective. He recovered without any neurologic sequelae. Our case was unusual encephalitis involving the unilateral hemisphere, which was benign and steroid-responsive.
Collapse
|