BACKGROUND: Middle cerebral artery (MCA) steno-occlusive disease is known to be more common in Eastern than in Western, however, clinical characteristics have not been well documented. We aimed to find clinical characteristics of isolated MCA disease comparing with other MCA steno-occlusive disease. METHODS: Patients with lesion in M1 portion of MCA divided into three groups by angiographic finding ; isolated MCA stenosis (IMCAS, n=39), isolated MCA occlusion (IMCAO, n=29), and multiple (ICA, BA or VA) steno-occlusion involving MCA (Combined, n=48). Patients with evidence of cardioembolic MCA occlusion and Moyamoya disease were excluded. We analyzed clinical features, neuroimaging findings, and prognosis retrospectively. RESULTS: MRI showed large deep (36%), small deep (26%), cortical (21%), and mixed (cortical & deep, 15%) infarct in IMCAS group ; mixed (38%), large deep (21%), small deep (17%), and cortical (17%) infarct in IMCAO group ; large deep (31%), cortical (23%), small deep (17%), and no lesion (17%) in Combined group. Site of MCA steno-occlusion on angiogram was middle (44%), distal (39%), and proximal (18%) in IMCAS group ; proximal (48%), middle (35%), and distal (17%) in IMCAO group ; middle (42%), proximal (31%), and distal (27%) in Combined group. Patient's neurologic status, assessed by NIHSS, during first 7 days was 'not changed' or 'worsening' (>93%) in all 3 groups. Neurologic outcome at 3 months later was improving (65%) in IMCAS group by modified Rankin scale. CONCLUSIONS: Isolated MCA stenotic disease was not significantly different from iso-lated MCA occlusion group or Combined group in clinical features, neuroimaging findings, and prognosis.
Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Moyamoya Disease ; Neuroimaging ; Prognosis ; Retrospective Studies

Pulmonary blastoma is a rare lung tumor resembling fetal lung tissue. Pathologically the tumor can be classified to 2 groups, well-differentiated fetal adenocarcinoma(WDFA) and biphasic blastoma. WDFA has more favorable prognosis with fewer metastasis at initial presentation and fewer recurrence after treatment. We experienced a case of pulmonary blastoma in 32-year-old female patient. The patient was referred to our hospital because of abnormal mass shadow in right middle lobe. The diagnosis of pulmonary blastoma(WDFA type, Stage I T2NOMO) was confirmed after right middle lobectomy. We followed up 22 months without an evidence of recurrence.
Adult ; Diagnosis ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Prognosis ; Pulmonary Blastoma* ; Recurrence

Purpose: The study was aimed at assessing the prevalence of depression in individuals with fecal incontinence (FI) and the relationship between the symptoms of depression and the severity of objective test parameters. Methods: Patients with FI for over 3 months were included in the study. The exclusion criteria were (1) diagnosis or treatment of the pelvic organ prolapse syndrome, (2) previous anorectal surgery, (3) inflammatory bowel disease, (4) previous diagnosis of psychiatric disorder, and (5) inability to read or understand the questionnaire themselves. The questionnaire included the Beck Depression Inventory-II (BDI-II) for measuring depression, and 142 patients were included for analysis. Results: Of the 142 patients, 34 were males and 108 were females, with a mean age of 67.8 years. The mean duration of FI symptoms was 38.36 months (range, 3–600 months). The mean Cleveland Clinic Incontinence Score and BDI-II were 11.96 ± 4.76 and 12.46 ± 9.84, respectively. The Cleveland Clinic Incontinence Score showed a positive correlation with the BDI-II score (P = 0.005). Of the 142 patients, 99 showed minimal to mild BDI-II scores, and 43 showed moderate-to-severe BDI-II scores. The multivariable logistic regression analysis showed that health insurance status was related to the depression in FI patients. Conclusion Mood disorders related to FI are more affected by the severity of the subjective symptoms or the surrounding environment than the objective indicators derived from the test.

Purpose: The study was aimed at assessing the prevalence of depression in individuals with fecal incontinence (FI) and the relationship between the symptoms of depression and the severity of objective test parameters. Methods: Patients with FI for over 3 months were included in the study. The exclusion criteria were (1) diagnosis or treatment of the pelvic organ prolapse syndrome, (2) previous anorectal surgery, (3) inflammatory bowel disease, (4) previous diagnosis of psychiatric disorder, and (5) inability to read or understand the questionnaire themselves. The questionnaire included the Beck Depression Inventory-II (BDI-II) for measuring depression, and 142 patients were included for analysis. Results: Of the 142 patients, 34 were males and 108 were females, with a mean age of 67.8 years. The mean duration of FI symptoms was 38.36 months (range, 3–600 months). The mean Cleveland Clinic Incontinence Score and BDI-II were 11.96 ± 4.76 and 12.46 ± 9.84, respectively. The Cleveland Clinic Incontinence Score showed a positive correlation with the BDI-II score (P = 0.005). Of the 142 patients, 99 showed minimal to mild BDI-II scores, and 43 showed moderate-to-severe BDI-II scores. The multivariable logistic regression analysis showed that health insurance status was related to the depression in FI patients. Conclusion Mood disorders related to FI are more affected by the severity of the subjective symptoms or the surrounding environment than the objective indicators derived from the test.

BACKGROUND:There is little knowledge regarding the possible pathogenetic mechanism of cerebrovascular disease occurring during sleep. We conducted a prospective study using ambulatory blood pressure monitoring to elucidate the specific characteristics and mechanism in cerebrovascular disease occurrence during sleep. METHODS: Stroke were cat-egorized into the small artery disease and large artery disease, cardiogenic disease, and intracerebral hemorrhage. 24- hour ambulatory blood pressure was carried out within 7 days after stroke onset in 20 patients (11 small artery disease, 7 large artery disease, 1 hemorrhage, 1 Moyamoya disease), and in 21 control patients (10 small artery disease, 9 large artery disease, 2 hemorrhage), that were admitted with stroke occuring during awakening time. The mean day-time and night-time systolic and diastolic blood pressure, mean day-time and night-time pulse rate, percentage of nocturnal blood pressure ([mean daytime BP - mean nighttime BP / average BP for the entire 24 hour] x100) were calculated. RESULTS: There was no significant difference between patients with cerebrovascular disease occurring during sleep and controls in mean day-time and night-time systolic and diastolic blood pressure, mean day-time and night-time pulse rate. Absence of normal nocturnal blood pressure dip in all stroke subtypes was noted. But, the magnitude of reduced nocturnal blood pressure decline in small artery disease group was significant smaller than in large artery disease and control groups (p<.005). CONCLUSIONS: Relatively preserved nocturnal blood pressure dip in small artery disease group with cerebrovascular disease occurring during sleep is thought that the cerebral ischemia in this subgroup is produced by excessive falls in the nighttime blood pressure or lowering of night-time blood pressure by antihypertensive agents.
Antihypertensive Agents ; Arteries ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Brain Ischemia ; Cerebral Hemorrhage ; Heart Rate ; Hemorrhage ; Humans ; Prospective Studies* ; Stroke

Chronic acquired hepatocerebral degeneration (CAHD) is a progressive or episodic neurologic syndrome that occurs occasionally in patients who have chronic liver disease or portocaval shunt. The clinical features of CAHD include action and postural tremors, generalized chorea, asterixis, myoclonus, dystonia, resting tremor, gait ataxia, and variable impairments of intellectual function. We experienced 2 cases of CAHD with unusual neurologic manifestations, which were hypokinetic parkinsonian symptoms. Both cases had a history of liver cirrhosis and the same symptoms. They had masked faces, cogwheel rigidiy in both wrists, slurred speech, tongue tremor, bradykinesia, and gait ataxia. They had normal mental status and no pathologic reflex. Brain MRI showed abnormal, increased signal on T1-weighted images in the globus pallidus and mesencephalon bilaterally. The hypokinetic parkinsonian symptoms disappeared when given doses levodopa.
Brain ; Chorea ; Dyskinesias ; Dystonia ; Gait Ataxia ; Globus Pallidus ; Hepatolenticular Degeneration* ; Humans ; Hypokinesia ; Levodopa ; Liver Cirrhosis ; Liver Diseases ; Magnetic Resonance Imaging ; Masks ; Mesencephalon ; Myoclonus ; Neurologic Manifestations ; Reflex ; Tongue ; Tremor ; Wrist

No abstract available.
Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Humans ; Lung*

No abstract available.
Adenosine* ; Diagnosis* ; Radionuclide Imaging*

We compared the recurrence rate, survival and functional results of 159 low rectal cancer patients retrospectively, who had been performed 75 sphincter saving resections (SSR) and 84 abdomino-perineal resections(APR) during July 1989 to December 1994. The local recurrence rate was 9.3% in SSR and 8.3% in APR group, while systemic recurrence rate was 20.5% and 16.7%, respectively(p>0.05). Three year survival rate was 70% in SSR and 85% in APR group. Comparing with Dukes'stage, it was 69%, 89% in Dukes'B and 63%, 84% in Dukes'c stage, respectively(p>0.05). In respect to the number of metastatic lymph node,3 year survival rate was 80%,95% in Nl group(< OR =3 metastatic lymph nodes) and 61%,72% in N2 group(> OR =4 metastatic lymph nodes), respectively(p>0.05). According to the distal resection margin(DRM), it was 100% in group 1(1 cm< OR =DRM<2 cm), 63% in group 2(2 cm< OR =DRM < 3 cm) and 72% in group 3(DRM> OR = 3 cm), respectively(p>0.05). Voiding dysfunction was developed 36.0% of SSR and 28.6% of APR postoperatively. Erectile and ejaculatory dysfunction rate was 33.3%, 66.7% of SSR and 58.8%, 88.3% APR group respectively, There were no significant differences in recurrence rate, survival rate and functional results Between SSR and APR group. Conclusively, sphincter saving resection in low rectal cancer surgery did not seem to affect survival or recurrence. A good functional outcome in the SSR suggests it to be a procedure of choice, if possible.
Humans ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate

A subluxation or dislocation of the carpometacarpal joint of the thumb is a rare injury, which usually occurs from trauma. There is a relative dearth of literature about the results of hand surgery for the treatment of Ehlers-Danlos syndrome. To the best of our knowledge, there has been no report on capsular ligament reconstruction in the hand using an autogenous tendon graft for the treatment of Ehlers-Danlos syndrome. We describe a case of atraumatic dislocation of the carpometacarpal joint of the thumb that had gradually progressed in a patient with Ehlers-Danlos syndrome; and which was treated with capsular ligament reconstruction by use of a portion of the flexor carpi radialis tendon. Six months after surgery, a trapeziometacarpal arthrodesis was performed secondarily, because of subluxation and pain in the carpometacarpal joint of the thumb, with a pinching motion.
Arthrodesis ; Carpometacarpal Joints* ; Dislocations* ; Ehlers-Danlos Syndrome* ; Hand ; Humans ; Ligaments ; Tendons ; Thumb* ; Transplants