Rapid-eye-movement (REM) sleep behavior (RBD) is a form of REM sleep motor dyscontrol characterized by complex, vigorous, and frequently violent behaviors without atonia during the REM sleep. The motor dyscontrol may include not only cataplexy and sleep paralysis but alto periodic limb movements during REM and non-REM sleep. We examined two patients with charateristic episodes of behavioral manifestations during the REM sleep as well as with other sleep disorders such as narcolepsy and periodic limb movement disorder. The one patina was an 18 year-old man who had childhood-onset RBD associated with narcolepsy since 10 years old. The polysomnographic studies showed excessive augmentation of chin EMG and 6 attacks of violent behavior during REM sleep. He also complained of cataplexic symptomes. Multiple sleep latency tests (MSLT) showed four sleep onset REMs and two episodes of violent behavior during the REM sleep. The other patient was a 74 year-old man who complained of violent behaviors during the REM sleep and polysomnographic studies showed excessive augmentation of chin EMG during the REM sleep and periodic leg movements for 24min. And 14sec. During the sleep. We report two patients with RBD which were associated with narcolepsy, and periodic limb movememt disorder irrespectively, suggesting that RBD, narcolepsy and periodic limb movement disorder could occur coincidently and be understood as a motor dyscontrol during REM sleep.
Adolescent ; Aged ; Cataplexy ; Child ; Chin ; Extremities ; Humans ; Leg ; Mental Disorders* ; Narcolepsy* ; Nocturnal Myoclonus Syndrome* ; REM Sleep Behavior Disorder ; Sleep Wake Disorders ; Sleep Paralysis ; Sleep, REM*

No abstract available.
Breast Neoplasms* ; Breast* ; Lymph Node Excision* ; Lymph Nodes* ; Mastectomy, Segmental* ; Radiotherapy*

Continuous electroencephalographic (EEG) monitoring is the widely used method of operative surveillance during carotid endarterectomy. EEG changes have been well known when cerebral ischemic event occurs during the carotid endarterectomy. But in our country intraoperative EEG monitoring during the operation was not popular and was not reported yet. We have experienced four patients showing EEG changes during the operation. EEG monitoring was performed using four channel differential montages in four patients with carotid artery disease. We evaluated the changes of EEG monitoring during the carotid endarterectomy. We also performed somatosensory evoked potentials (SEP) monitoring to backup the EEG monitoring which could miss the small embolic subcortical infarction. They revealed significant EEG changes which were the decreased fast activities and increased slowing during the carotid cross clamping. They were normalized after insertion of shunt. In one subject EEG change reappeared while the shunt was inserted, because the shunt was kinked, In all subjects, the significant changes of SEP were not observed after declamping of ICA or reposition of kinked shunt. There were not any immediate postoperative neurologic deficits in all patients. EEG monitoring might be considered as an useful method to detect ischemic changes during carotid endarterectomy and to know whether the inserted shunt is working well, Key Words : Intraoperative neuromonitoring, Carotid endarterectomy.
Carotid Artery Diseases ; Cerebral Infarction ; Constriction ; Electroencephalography ; Endarterectomy, Carotid* ; Evoked Potentials, Somatosensory ; Humans ; Neurologic Manifestations

BACKGROUND: Takayasu's arteritis is a chronic non-specific inflammatory disease of arteries and it is known that aorta and its major branches are most commonly invoved. Its etiology is still unknown but the basic process is marked intimal proliferation, fibrosis and fibrous scarring with degeneration of the elastic fibers of the media. The proliferative and cicatrical process leads to luminal narrowing, stenosis, localized aneurysm, postsenotic dilatation and calcification in the involved arterial wall. Little attention has been paid to the diagnostic value of transesophageal echocardiography(TEE) in Takayasu's arteritis. METHODS: We evaluated transesophageal echocardiographic findings of aortic lesions in 3 cases of Takayasu's arteritis. RESULTS: The transesophageal echocardiographic findings of aortic lesions in Takayasu's arteritis characteristically showed relatively long sehmental luminal narrowing caused by marked intimal proliferation and contracture fo aortic wasll. The morphology of intimal thickening was characteristically circumferential, concentric and the size of the aorta itself was decreased by contracture as compared with atherosclerotic changes involving aorta. Besides these findings were consistent with angiographic findings. The common types of Takayasu's arteritis which we will meet clinically are known as type I or III. Indeed, 3 cases described in this paper are all type 3 patients. According to that fact, most of Takayasu's arterits may have aortic lesions that could be easily accessible by TEE and the degree of deformity of the aorta can be evaluated using TEE. CONCLUSION: The transesophageal echocardiography may be a valuable diagnostic tool for the evaluation of aortic wall and luminal status in the patients with Takayasu's arteritis.
Aneurysm ; Aorta ; Arteries ; Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Contracture ; Dilatation ; Echocardiography* ; Echocardiography, Transesophageal ; Elastic Tissue ; Fibrosis ; Humans ; Phenobarbital ; Takayasu Arteritis*

We report a case of synchronous gastric adenocarcinoma and abdominal non-Hodgkin's lymphoma in a 56-year-old man. An explo-laparotomy was performed for the purpose of palliative resection of the stomach and to evaluate the nature of splenic and peri-pancreatic mass lesions. The pathologic stage of the gastric carcinoma was stage IB (T2N0M0) and the clinical stage of the diffuse large cell type lymphoma was IIA2S. Following surgery and chemotherapy, the patient is now in a disease-free state.
Abdominal Neoplasms/pathology ; Abdominal Neoplasms/diagnosis* ; Adenocarcinoma/pathology ; Adenocarcinoma/diagnosis* ; Case Report ; Human ; Lymphoma, Non-Hodgkin/pathology ; Lymphoma, Non-Hodgkin/diagnosis* ; Male ; Middle Age ; Neoplasm Staging ; Neoplasms, Multiple Primary/pathology ; Neoplasms, Multiple Primary/diagnosis* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/diagnosis* ; Tomography, X-Ray Computed

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

BACKGROUND: Although several hospital-based stroke studies were published, there has not been any reliable data representing the clinical characteristics of stroke in Korea. We analyzed the clinical characteristics of patients with ischemic stroke registered in the Korean Stroke Registry (KSR), which is the largest prospective hospital-based nation-wide stroke registry in Korea. METHODS: The KSR provided standardized protocols for collecting data, which includes the data of demographics, subtypes of stroke, risk factors, and neurological outcome at discharge. The brain imaging studies, including CT or MRI, were performed in all cases. RESULTS: KSR registered 10,811 patients of acute ischemic stroke between Nov. 2002 and Jun. 2004. The large-artery atherosclerosis was the most common subtype (37.3%), followed by small vessel occlusion (30.8%). Hypertension (65.4%) was the most common risk factor, followed by smoking (34.5%) and diabetes (28.3%). Although most of the hypertensive and diabetic patients had been diagnosed before the stroke, less than 45.4% and 32.5% of them were under regular control. The steno-occlusive lesion of extracranial carotid artery was only 29.3% and the ratio of intra- to extracranial artery disease was more than 2 in KSR. Only 20.5% of patients were admitted within 3 hours after stroke onset and 2.1% were treated with intravenous thrombolysis. In-hospital case-fatality was 5.2%, which is relatively comparable to those of previous studies. CONCLUSIONS: The KSR provided informative data in understanding the clinical characteristics of ischemic stroke in Korea. Further analysis of KSR will facilitate clinical trials and development of guidelines for the management of stroke patients.
Arteries ; Atherosclerosis ; Carotid Arteries ; Cerebrovascular Disorders ; Demography ; Epidemiology ; Humans ; Hypertension ; Korea ; Magnetic Resonance Imaging ; Neuroimaging ; Prospective Studies* ; Registries ; Risk Factors ; Smoke ; Smoking ; Stroke*

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*