OBJECTIVES: Transcranial magnetic stimulation(TMS) is a new, noninvasive procedure of a localized pulsed magnetic field to the surface of the head to cause a depolarization of neurons in the brain cortex underneath. The magnetic field(Magnetic) is generated by passing current pulses by conducting coil, held close to the scalp so that the field is passing the skull(Transcranial) and is focused in the cortex(Stimulation). Here we provide a summarized review of the methodology of TMS and its application to research and therapeutics in the field of neuropsychiatry. METHODS: We described the history, procedures, basic researches, clinical applications, safety issues, mode of action, and future of TMS using literature review and interview with experts. RESULTS: The earlier clinical uses of TMS had been restricted to the field of neurology where it was used to examine the central and peripheral nervous conduction. However this technology has been widely used to map various brain functions such as visual information processing, language, memory, emotion, and movement. The ability to excite local areas of brain cortex has raised the possibility of the use of TMS as a novel therapeutic tool for various psychiatric disorders. CONCLUSION: TMS is a relatively new and noninvasive method to investigate regional brain activity and to treat several psychiatric diseases. Further work is necessary to firmly establish the efficacy and safety of this promising tool.
Automatic Data Processing ; Brain ; Head ; Magnetic Fields ; Memory ; Neurology ; Neurons ; Neuropsychiatry* ; Scalp ; Transcranial Magnetic Stimulation*

Generally, the posterolateral approach had been recommended in case of extraforaminal disc herniation or lateral stenosis but it has been speculated that this procedure may be feasible to posterolateral disc herniation at the high lumbar levels of the L1-L2 interspace. Topographically, a posterolateral approach should be able to access anteromedial side of the spinal canal without the risk of the bony instability and damage to the neural structures. During the past one year period, three patients with high lumbar discs at the L1-L2 level were treated by the modified posterolateral approach. This article describeds the details of this approach with pertinent literature review.
Constriction, Pathologic ; Humans ; Spinal Canal

The cerebral arteriovenous malformation(AVM) rarely coexists with primary intracranial tumor. The authors experienced a patient with intracerebral hematoma due to AVM rupture in whom intracranial meningioma and intracranial aneurysms coexisted. The meningioma was located at convexity of right frontal lobe, and arteriovenous malformation at temporo-occipital lobe of same hemisphere with feeding from right middle cerebral artery, and three intracranial aneurysms exist at the cavernous portion of right internal carotid artery, AVM feeding artery, and intranidal of the AVM. The authors report a rare case of coexisted intracranial AVM, meningioma and aneurysms with review of literatures.
Aneurysm* ; Arteries ; Arteriovenous Malformations ; Carotid Artery, Internal ; Frontal Lobe ; Hematoma ; Humans ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations* ; Meningioma* ; Middle Cerebral Artery ; Rupture

Lymphangioma is a rare benign developmental vascular tumor that may be found in orbit, skull and elsewhere in head and neck. Few cases of extension of this benign but insidious tumor posteriorly out of the bony orbital cavity have been reported. The patient was 40-year-old man complaining of proptosis of right eye for one month. Physical examination revealed severe right exophthalmus, impairment of eyeball movement in all directions. Visual acuity was much impaired and he could percept only light with right eye. CT and MRI scans showed intraconal and extraconal involvement of ill-defined, heterogenous mass with extension of the tumor posteriorly beyond the orbital cavity involving right frontal and temporal lobe, skull and subcutaneous tissue. The tumor was subtotally removed via orbito-frontal approach without damaging vital neural and orbital component. Then, orbital roof reconstruction and cranioplasty were done with resin. Successful surgical removal of lymphangioma is very difficult due to its severe infiltration to surrounding tissue and tendency to bleed during debulking. We report a rare case of orbital cavernous lymphangioma with intracranial extension treated with surgical decompression, with review of literatures.
Adult ; Decompression, Surgical ; Exophthalmos ; Head ; Humans ; Lymphangioma* ; Magnetic Resonance Imaging ; Neck ; Orbit* ; Physical Examination ; Skull ; Subcutaneous Tissue ; Temporal Lobe ; Visual Acuity

We present two cases of deep cerebral venous thrombosis(DCVT) with the totally occluded straight sinus. A 42-year-old female received with altered mentality . She has taken antihistamine for six years to treat the paranasal sinusitis. Another 34-year-old female who used the oral contraceptive for 11 months presented with acute behavior change . Both of these patients were diagnosed by computed tomography(CT), magnetic resonance(MR) imaging, and cerebral angiography. They were fully recovered with systemic urokinase thrombolysis followed by heparin therapy. We report that the intravenous thrombolysis was potentially effective management strategy in our cases of DCVT with the totally occluded straight sinus.
Adult ; Cerebral Angiography ; Female ; Heparin* ; Humans ; Sinusitis ; Urokinase-Type Plasminogen Activator* ; Venous Thrombosis*

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by a severe idiosyncratic reaction including rash and fever, often with associated hepatitis, arthralgias, lymph node enlargement, or hematologic abnormalities. The mortality rate is approximately 10%, primarily owing to liver failure with massive or multiple disseminated focal necrosis. Here, we report a case of a 14-year-old girl treated with vancomycin because of a wound infection by methicillin-resistant Staphylococcus aureus, who presented with non-specific symptoms, which progressed to acute liver failure, displaying the hallmarks of DRESS syndrome. With the presence of aggravated hepatic encephalopathy and azotemia, the patient was refractory to medical treatments, she received a living-donor liver transplantation, and a cure was achieved without any sign of recurrence. Vancomycin can be a cause of DRESS syndrome. A high index of suspicion and rapid diagnosis are necessary not to miss this potentially lethal disease.
Arthralgia ; Azotemia ; Child ; Eosinophilia ; Exanthema ; Fever ; Hepatic Encephalopathy ; Hepatitis ; Humans ; Liver ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Lymph Nodes ; Methicillin-Resistant Staphylococcus aureus ; Necrosis ; Recurrence ; Vancomycin ; Wound Infection

PURPOSE: Early diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL)-6 and IL-8 in children with acute pyelonephritis. METHODS: Eighty-seven patients between 1 month to 12 years old with urinary tract infection (UTI) were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid renal scan: acute pyelonephritis (n=37) and lower UTI (n=50) groups. White blood cell (WBC) count, neutrophil (Neutl) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared. RESULTS: There was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05). In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively). The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP. CONCLUSION: This study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI.
C-Reactive Protein ; Child ; Early Diagnosis ; Erythrocyte Count ; Humans ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Leukocytes ; Neutrophils ; Platelet Count ; Pyelonephritis ; Sensitivity and Specificity ; Urinary Tract Infections

PURPOSE: Sleep onset association disorder (SOAD) is a form of behavioral insomnia observed in children that is caused by inappropriate sleep training. SOAD typically disturbs the sleep of not only infants and children but also their parents. We investigated levels of depression and marital intimacy among parents of infants with typical SOAD, to understand the influence of SOAD on family dynamics, as well as examine ways for improving depression and marital intimacy through behavioral training. METHODS: Depression and marital intimacy were assessed using the Beck Depression Inventory (BDI) and Waring Intimacy Questionnaire (WIQ). These measures were administered to 65 parents of infants (n=50) diagnosed with SOAD. We conducted sleep education and behavioral training for the parents and compared levels of depression and marital intimacy after 2-6 weeks of training. RESULTS: The 65 parents consisted of 50 mothers and 15 fathers. Depressive symptoms were higher among mothers than fathers (P =0.007). Marital intimacy was negatively correlated with depressive symptoms. Twenty-six parents were assessed again after sleep training. We found that mothers' depressive symptoms and marital intimacy improved post training. CONCLUSION: SOAD can be detrimental to both infants and parents, especially for parents who sleep with their infants. For instance, disruption of sleep patterns in such parents can reduce marital intimacy. However, behavioral modification is an effective treatment for infants with frequent nighttime waking, as well as for diminishing the depressive symptoms of sleep-deprived parents.
Child ; Depression ; Fathers ; Humans ; Infant ; Mothers ; Parents ; Surveys and Questionnaires ; Sleep Initiation and Maintenance Disorders

PURPOSE: The aim of this study was to recognize the state of vitamin D among healthy infants aged 1 to 6 months in South Korea, and also to identify the risk factors affecting the level of vitamin D. METHODS: A total of 117 infants were enrolled in this study for 12 months, from March 1, 2011 to February 29, 2012. Serum levels of 25-hydroxyvitamin D (25[OH]D), calcium, phosphorus, and alkaline phosphatase were measured and data including birth weight, body weight, sex, feeding pattern, delivery mode, siblings and maternal age and occupation were collected. Data was mainly analyzed with independent t-test model. RESULTS: We determined that the prevalence of vitamin D deficiency (serum 25[OH]D<20 ng/mL [50 mmol/L]) was 48.7% in the population investigated. Particularly in breastfed infants, the prevalence of vitamin D deficiency was strikingly high (90.4%). The mean serum level of 25(OH)D in breastfed infants was lower than that of formula fed infants (9.35 ng/mL vs. 28.79 ng/mL). Also female infants showed lower mean serum level of 25(OH)D than male. Mean serum values of calcium and phosphorus had positive correlation with vitamin D state (P<0.001). CONCLUSION: Vitamin D deficiency was found to be very common in infants aged 1 to 6 months in South Korea, and breast feeding was the most critical risk factor of vitamin D deficiency. Therefore we suggest to start vitamin D supplementation in South Korea, as soon as possible, to all infants, including breastfed and female infants.
Aged ; Alkaline Phosphatase ; Birth Weight ; Body Weight ; Breast Feeding ; Calcium ; Feeding Behavior ; Female ; Humans ; Infant ; Male ; Maternal Age ; Occupations ; Phosphorus ; Prevalence ; Republic of Korea ; Risk Factors ; Siblings ; Vitamin D ; Vitamin D Deficiency ; Vitamins

No abstract available.
Vitamin D ; Vitamins