BACKGROUND AND PURPOSE: Many literatures indicate that executive dysfunction exists in mild cognitive impairment (MCI) as well as Alzheimer’s disease (AD). However, there are few studies that found how early the deficits of the executive function (EF) exist in MCI. The present study investigated the presence of executive dysfunctions in the earliest stage of MCI, and the sub-domains of EF which are disproportionately impaired earlier than others. METHODS: The participants were 41 normal elderly (NE), 86 with amnestic multi-domain MCI, and 41 with mild AD. The MCI group was further sub-divided into two groups: Early MCI (EMCI, n=45) and late MCI (n=41), based on the Clinical Dementia Rating-Sum of Boxes. All participants were given neuropsychological tests to assess the sub-domains of EF, such as verbal fluency, psychomotor speed, inhibitory control, and mental set-shifting. RESULTS: Impairment of semantic fluency was observed in EMCI, with gradual worsening as cases approached mild AD. Phonemic fluency and psychomotor speed were also impaired at the early stage of MCI relative to the NE, but maintained at the same level up to mild AD. EMCI exhibited the same degree of performance with NE for inhibitory control and mental set-shifting; however, they progressively worsened from EMCI to mild AD. CONCLUSIONS: These results suggest that impairments of EF exist even in the earliest stage of the MCI, with a disproportionate decline in the sub-domains of EF.
Aged ; Alzheimer Disease* ; Dementia ; Executive Function* ; Humans ; Mild Cognitive Impairment* ; Neuropsychological Tests ; Semantics

No abstract available.
Craniocerebral Trauma* ; Head* ; Protons*

PURPOSE: The objective of this study is to investigate the malignancy rates of BIRADS 4 and 5 lesions detected on annual screening or follow-up US and to correlate the malignancy rates with the rationales for biopsy. MATERIALS AND METHODS: Between 2010 and 2011, among 2837 patients who underwent US-guided core-needle biopsy, 423 patients underwent screening or regular follow-up US examinations. Lesions were classified into four groups: newly detected suspicious lesions, benign lesions with interval growth, benign lesions with suspicious changes of US features and benign lesions with interval growth and suspicious changes of US features. RESULTS: The malignancy rates were as follows: BI-RADS 4A low suspicion of malignancy, 8.1% (31/379); 4B intermediate suspicion of malignancy, 56% (14/25); 4C moderate suspicion of malignancy, 71.4% (10/14); 5 highly suggestive of malignancy, 100% (5/5). The malignancy rates for the four groups were as follows: newly detected suspicious lesions, 17.46% (51/292); benign lesions with interval growth, 7.77% (7/90); benign lesions with suspicious changes of US features, 4% (1/25); benign lesions with interval growth and suspicious changes of US features, 6.25% (1/16). Comparison of the malignancy rate of newly detected suspicious lesions with that of benign lesions with interval growth revealed a statistically significant difference (p=0.038). No significant differences were observed between the other groups (p>0.05). CONCLUSION: The malignancy rates of suspicious lesions detected on annual screening or follow-up US were similar to those of the reported BI-RADS data. A higher malignancy rate was observed for newly detected suspicious lesions than for lesions with interval growth.
Biopsy ; Biopsy, Large-Core Needle ; Breast Diseases ; Breast* ; Follow-Up Studies* ; Humans ; Mass Screening* ; Ultrasonography*

No abstract available.
Hemiarthroplasty* ; Hemorrhage* ; Hip* ; Hypotension* ; Retrospective Studies*

The vascular actions of local anesthetics are important in determining the uptake and distribution of these agents from their site of injection as well as influencing their hemodynamic effects once absorbed. Because of the importance of the endothelium in determining of modulating the vascular response of a wide variety of agents, cumulative dose-dependent vasular effects of lidocaine, mepivacaine and bupivacaine on isolated rings of thoracic aorta in normotensive rats(NTR) and spontaneously hypertensive rats(SHR) were studied in the presence and absence of intact endothelium. The results were as follows ; The body weight of NTR and SHR averaged 274.71+/-55.80(N = 38) and 241.43+/-17.73gm(N = 18) and mean arterial pressure was 74.4l+/-3.60 and 129.34+/-2.89mmHg respectively. The mean absolute value of the contraction induced by 5Xl0(-6) M phenylephrine was 3.27+/-0.98(N = 18) and 2.3l+/-50.64gm(N = 18) with intact endothelium and 3.12+/-0.92 and 2.46+/-0.87 gm without intact endothelium in aortic rings of NTR and SHR respectively. In the response to local anesthetics in preparation with resting tension(1.0 gm), lidocaine and mepivacaine in concentration of 10(-3) to 1.25X10(-2) M not produced dose dependent contraction in aortic ring with intact endothelium from NTR. but bupivacaine produced dose-dependent contraction in aortic rings with intact endothelium from NTR. In the aortic rings from NTR and SHR previously contracted with phenylephrine, lidocaine in contraction of 10(-3) to 1.25X10(-2) M caused dose related relaxation in aortic rings with or without endothelium but in concentration of 10(-3) to 510(-3) M, aortic rings with endothelium were more relaxed than those af without endothelium in NTR. In SHR, aortic rings without endothelium in concentration of 5X10(-3) to 1.25X10 M were more significantly relaxed than those of with endothelium. In aortic rings from NTR previously contracted with phenylephrine, mepivacaine caused dose-related relaxation, which was more profound in SHR. In aortic rings with endothelium from NTR previously contracted with phenylephrine, bupivacaine in concentration of 10(-3) to 1.5X10(-3) M caused a relaxation and in concentration of 2.5X10(-3) to 7.5X10(-3) M and 1.25X10(-3) M caused a relaxation again. But in the aortic rings without intact endothelium, bupivacaine caused dose-related relaxation. In the aortic rings without intact endothelium, bupivacaine caused dose-related relaxation in NTR. In the aortic rings from SHR previously contracted with phenylephrine, bupivacaine caused dose-related relaxation, which was more profound than those of NTR. The local anesthetics appear to exert their relaxant effect on endothelium independently and more profoundly in SHR.
Anesthetics, Local* ; Aorta, Thoracic* ; Arterial Pressure ; Body Weight ; Bupivacaine ; Endothelium ; Hemodynamics ; Lidocaine ; Mepivacaine ; Muscle, Smooth, Vascular ; Phenylephrine ; Rats, Inbred SHR* ; Relaxation

PURPOSE: To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis. MATERIALS AND METHODS: Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon. RESULTS: On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC). CONCLUSION: The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Papilloma ; Retrospective Studies

Medial blowout fracture with persistent diplopia and enophthalmos was required surgical treatment. Conventionally, surgery of blowout fracture of the medial wall has been performed by the transorbital approach with external incision. The conventional method had some disadvantages of external scar, increased morbidity, and general anesthesia. We performed endoscopic endonasal surgery without external incision in 2 cases of medial blowout fracture under local anesthesia. The bony fragments were removed after the intranasal ethmoidectomy. And the entrapped medial rectus muscle was released from the bony fragments. Merocel(R) was placed in the ethmoid sinus for the support of the orbital defect for 48 hours. Results of the surgery in all 2 cases were satisfactory and there were no evidences of diplopia and enophthalmos so far.
Anesthesia, General ; Anesthesia, Local ; Cicatrix ; Diplopia ; Enophthalmos ; Ethmoid Sinus ; Orbit

Cryptotia is a congenital anomaly of the auricle that the upper pole of the auricular cartilage is buried beneath the skin of the scalp and auriculocephalic sulcus is obliterated. In addition, there is often a deformity of the antihelix, especially its superior crus. The principle of the surgery is to deepen the auriculocephalic sulcus, to correct deformed cartilage and to correct the malposition. For the correction of the bilateral cryptotia, we have applied the modified Ohmori's method and have obtained good result without complication. We report this case with a review of related literature.
Cartilage ; Congenital Abnormalities ; Ear Cartilage ; Scalp ; Skin

BACKGROUND AND PURPOSE: Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia. METHODS: Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems. RESULTS: On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE. CONCLUSIONS: The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.
Adult ; Alzheimer Disease ; Dementia* ; Dementia, Vascular ; Humans ; Mass Screening* ; Mild Cognitive Impairment* ; ROC Curve

Background: Recent progress in chronic cough management includes controlling cough triggers and hypersensitivity using antitussives. Therefore, we investigated the effects and safety outcomes of antitussives, codeine and levodropropizine, in patients with chronic cough. Methods: We conducted an open-label, randomized comparative trial with newly referred patients with chronic cough. Patients were orally administered codeine (60 mg/day) and levodropropizine (180 mg/day) for 2 weeks. Cough severity, including the visual analog scale (VAS), Cough Symptom Score (CSS), Leicester Cough Questionnaire (LCQ), and safety for each treatment were assessed. The primary outcome was VAS score changes before and after 2 weeks of treatment. Results: Among the 88 participants, 45 and 43 in the codeine and levodropropizine groups, respectively, were included in the analysis. Changes in the VAS score were higher in the codeine group than in the levodropropizine group (35.11 ± 20.74 vs. 19.77 ± 24.83, P = 0.002). Patients administered codeine also had improved CSS (2.96 ± 2.35 vs. 1.26 ± 1.89, P < 0.001) and LCQ (3.28 ± 3.36 vs. 1.61 ± 3.53, P = 0.025) than those administered levodropropizine. Treatment-related adverse events, including drowsiness, constipation, and headaches, were more frequent in the codeine group than in the levodropropizine group. However, no significant differences existed in the adverse events leading to discontinuation. Conclusion Codeine is an effective and generally well-tolerated antitussive for chronic cough. However, it may induce side effects in some patients. Individual responses and adverse events should be carefully monitored when codeine is used to treat chronic cough.