BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.
Aged ; Alzheimer Disease ; Asia ; Dementia ; Dementia, Vascular ; Developing Countries ; Electroencephalography* ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Infarction* ; Prognosis* ; Vascular System Injuries

Preperative radiologic indices, such as cortical index of Engh, morphological cortical index of Sportono and Romagnoli, canal flare index of Noble, and their relationship to the postoperative canal filling, femoral stem fitness, stability and clinical result at last follow up were analyzed in 111 hips of 96 patients treated with bipolar or total hip arthroplasty at the Department of Chthopedic Surgery, Korea University Hospital, between January 1985 and May 1993. The results obtained were as follows: 1. The cortical index had no correlations with age, metaphyseal filling and clinical result but isthmic filling was proportional to the cortical index. In femoral stem fitness and stability, most cases of press fit and optimal stability were obtained in group 3 and 4 that have thick cortex. 2. The morphological cortical index had no correlation with age, canal filling and clinical results. But it was proportional to the postoperative femoral stem fitness and stability. 3. The canal flare index had no correlation with age. The metaphyseal filling was increased in the stove piped canal group(less than 3.0 canal flare index), but isthmic filling was increased in normal canal group(3.0-4.7 canal flare index). The most cases of press fit and optimal stability were obtained in normal canal group. More satisfactory clinical results were obtained in nomal canal group. Above results suggest that straight type of cementless femoral component could get better press fit fixation, postoperative stability and more satisfactory clinical results in the cases of cortical index larger than 2.0, mophological cortical index larger than 2.7 and canal flare index larger than 4.0 but metaphyseal filling is unsatisfactor.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Korea

Objective: Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiological findings in neurologically asymptomatic elderly people. Their presence is associated with an increased risk of stroke or dementia. Homocysteine (Hcy) can cause atherosclerosis and may thus act as a useful marker of stroke prior to symptom onset. This study aimed to evaluate the utility of Hcy as a surrogate marker for early intervention for stroke in community-dwelling healthy elderly persons with cerebrovascular lesions such as WMCs and SBIs. Methods: We assessed the relationship between the Hcy level and presence of WMCs/SBIs on brain computed tomography (CT) in 554 elderly individuals aged ≥65 years with no history of stroke or dementia. Results: The mean age of the participants was 74.43±7.32 years. Of the 554 patients, 106 (19.1%) had WMCs and/or SBI findings on brain CT. The mean Hcy level was higher in participants with WMCs/SBIs (P=0.001). The WMCs/SBIs group had a significantly greater number of participants with high Hcy levels than the non-WMCs/SBIs group (P<0.001). High Hcy levels (≥12.3 μmol/L) was significantly associated with WMCs and SBIs even after adjusting for age, Korean Mini Mental Status Examination score, education level, and vascular risk factors such as hypertension, diabetes, hyperlipidemia and smoking status. Conclusion: The result of our study suggests that regular monitoring of homocysteine level as a modifiable risk factor may be helpful for predicting the association of cerebrovascular lesions such as WMCs and SBIs for the prevention of future ischemic stroke and cognitive impairment.

No abstract available.
Elbow Joint* ; Elbow*

Beckwith-Wiedemann syndrome is a rare clinical entity characterized by exomphalos, macroglossia, macrosomia, and renal hyperplasia/dysplasia. Although its entity is established, its etiology and obligatory features have not been settled. We report an autopsy case with the unusual involvement of the salivary gland. This infant was born to a 37-year-old mother as a normal full-term spontaneous delivery. At 11 days of age she developed with purulent eye discharge and weak sucking, and died suddenly. At autopsy the baby weighed 2,630 gm and the head circumference was 35 cm. She showed thick and prominent skin folds, bilateral aural fissures, macroglossia, hepatomegaly, cardiomegaly, dysmorphic kidneys, and nesidioblastosis. Both kidneys showed dysplastic tubules and hyperplastic cortical tissue enclosing the medulla. In this case there were characteristic findings in major and minor salivary glands with both acinar and ductal hyperplasia, and hypertrophy of mammary glands. Besides, she had generalized depletion of subcutaneous fat, immature buccal fat, patent ductus arteriosus, hyperlobation of the right lung, two accessory spleens, and hyperplasia of basophils and chromophobes in the pituitary gland. The lungs showed diffuse interstitial pneumonia and multiple fibrin thrombi. There were no adrenal cytomegaly, umbilical hernia and exophthalmos.
Infant ; Male ; Female ; Humans

Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiologic findings in neurologically asymptomatic elderly people, but are associated with an increased risk of subsequent stroke. We investigated the prevalence and risk factors for these cerebral changes on brain computed tomography (CT) in 480 community-dwelling healthy Korean adults without stroke or dementia, who were recruited for an early health program. Cerebral WMCs were defined as the presence of approximately 5 mm wide ill-defined and moderately hypodense lesions, and SBIs were defined as the presence of >2 mm wide well-defined hypodense lesions. Of the 480 patients, 49 (10.2%) had cerebral WMCs and SBIs findings on brain CT. The prevalence of WMCs and SBIs increased with age: the prevalence was 2.4%, 9%, and 32% for subjects in their 50, 60s, and 70s, respectively. In addition, hypertension, abdominal obesity, increased levels of homocysteine and high sensitivity C-reactive protein were significantly associated with cerebral WMCs and SBIs. Our study suggests that regular monitoring of risk factors is required to prevent cerebral WMCs and SBIs and decrease the incidence of stroke and dementia in healthy individuals.

The combination of reflux and infection may produce progressive renal damage. If the V-U reflux is corrected, normal renal growth can be resumed in most cases, but some cases remain with reduced renal growth. 70 kidneys with V-U reflux during the past 5 years was reviewed clinically, so the following results were obtained; 1. The incidence of renal scar was noticed in 50% among 70 VUR cases, and the incidence and the severity of renal scar was increased according to the grade of VUR. 2. 33 cases (94.3%) of 35 cases with renal scar was associated with UTI, and in these cases the grade of renal scar was higher than no UTI cases. 3. Under the age of 4 years the incidence of renal scar was high as 23 (60.5%) out of 38 VUR cases. and over the age of 4 years the incidence of renal scar was low as 12 (37.5%) out of 32 VUR cases. 4. The length & width in VUR cases compared to normal for age was within normal limit, but the renal parenchymal thickness compared to normal was lower. In the higher grade of VUR the parenchymal thickness was thinner than in he lower grade. 5. In most cases of successfully treated VUR medically and surgically, renal parenchymal thickness was grown into the normal level. Although the VUR was treated successfully, renal parenchymal growth was retarded in the higher grade of VUR (more then IV) or more severe renal scar (more than b).
Cicatrix ; Incidence ; Kidney ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

Cryptococcal meningitis is a relatively common central nervous system infection by Cryptococcus neoformans. Before the introduction of amphotericin B in 1956, cryptococcal infection of the central nervous system had been almost uniformly fatal. Although amphotericin B(alone or in combination with flucytosine) has been the standard therapeutic regimen, problems such as modest efficacy, nephrotoxcity, other clinically significant toxicities, and the inconvinience of intravenous dosing have led to search for a new antimycotic agents. Fluconazole is a new therapeutic agent which is effective as amphoterin B. Accumulating evidence suggests that the antifungal triazole fluconazole represent an advance in the treatment of cryptococcal meningitis, particulary in acquired immunodeficiency syndrom patients. Thus we report clinical experiences of fluconazole therapy for 5 cases of cryptococcal meningitis. Four of 5 patients are improved clinically and microbiologically, 1 of 5 patients is expired due to concomittent tuberculous infection.
Amphotericin B ; Central Nervous System ; Central Nervous System Infections ; Cryptococcus neoformans ; Fluconazole* ; HMGB1 Protein ; Humans ; Meningitis, Cryptococcal*

A 54 year-old woman presented with bilateral fatigable blepharoptosis with diurnal fluctuation and diplopia for 10 days. She had a 3 year history of hypertension and showed symptoms of bilateral ptosis, supranuclear upward gaze palsy, and vertical diplopia with the pupils promptly constricting to light. Bell's phenomenon and vertical oculocephalic responses were intact but an impaired convergence was noted in both eyes. A intramuscular neostigmine test was negative. T1 and T2-wighted MRI of the brain showed a small round high signal intensity lesion in the periaqueductal gray (PAG) region. Therefore, she was diagnosed with a midbrain ptosis due to midbrain hemorrhage. The PAG lesion was suggested as contributing to the fatigable blepharoptosis and supranuclear upward gaze palsy in the patient. We recommend that patients with clinical features of myasthenia limited to the ocular muscles and, having risk factors for cerebrovascular disease, be thoroughly evaluated for intracranial lesions if warranted.
Blepharoptosis ; Brain ; Diplopia ; Female ; Hemorrhage* ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Mesencephalon* ; Middle Aged ; Muscles ; Neostigmine ; Paralysis ; Periaqueductal Gray ; Pupil ; Risk Factors

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*