Background and Objectives: This study aimed to examine factors of poor outcome by analyzing the outcomes of bilateral subthalamic deep brain stimulation in Parkinson’s disease after 3 years. Methods: We assumed that patients who could not manage independent life in their best stimulationon/medication-on condition after a defi ned period might not have been a good surgical candidate. A poor outcome is defi ned as a failure to maintain functional independence at three years during a stimulation-on/medication-on state. Results: A total of 84 patients underwent bilateral subthalamic deep brain stimulation and all were followed up for 3 years. We excluded one patient who had intracranial hemorrhage. Twenty-one patients of the 83 patients could not keep up independent life even during their best condition for the following reasons: freezing in 15 patients, dementia in 5, depression in 3, musculoskeletal problems in 7, and cancer in one patient. Conclusions: Many patients could not keep up independent life during their best condition as early as three years after deep brain stimulation. Musculoskeletal problems were one major cause of disabilities, as were freezing and dementia. We emphasize that musculoskeletal problems need more attention in the preoperative screening of deep brain stimulation candidates and during the follow up.

No abstract available.
Nitric Oxide Synthase Type II* ; Nitric Oxide* ; Porphyromonas gingivalis* ; Porphyromonas*

BACKGROUND: It is reported that abnormal eating behavior is more frequent in the group of weight control than those of no control. Repeated and chronic binge eating behavior has associations with impaired work and social functioning, overconcerns with body shape and weight. The purpose of this study is to investigate the degree of abnormal eating behavior according to weight management, depression level and obesity. METHODS: From June 1999 to July 1999, we collected self record questionnaire including body mass index(BMI), Beck Depression Inventory(BDI), Eating Attitude Test(EAT) from 1292 students of one girl's high school in Seoul. Study subjects were divided by BMI, the set point was 25 kg/m2. EAT score associated with weight control, BMI, BDI, smoking and alcohol was assessed by multiple linear regression. Study subjects were also grouped by the existence of the history of weight management behavoir, then BMI, EAT score and BDI in each subgroups was assessed by t test. RESULTS: Obese students were 42, whereas those of BMI under 25 kg/m2 were 1191. BDI score ranging from 5 to 20 were 940, 21 to 63 were 179. The EAT score has significant relevance to the history of weight control, BMI, and BDI score in order. The EAT score and BMI were higher in the subjects who experienced various modes of weight control (48.41+/-14.47 vs 33.63+/-12.52 in EAT, 20.34+/-2.26 vs 18.72+/-1.89)(p<0.01). CONCLUSION: EAT score was associated with weight control, BMI and BDI. EAT score and BMI were higher in weight control samples.
Bulimia ; Depression* ; Eating ; Feeding and Eating Disorders ; Feeding Behavior ; Humans ; Linear Models ; Obesity ; Seoul ; Smoke ; Smoking ; Surveys and Questionnaires

The Currarino triad is a unique complex of congenital caudal anomalies, including anorectal malformation, sacral bony defect and presacral mass. This triad may be associated with Mullerian duct anomalies, such as duplication of the vagina and uterus. Each of these diseases has a familial tendency and sometimes coexist within families. But, when coexisting in familial cases, nearly all reported cases revealed mutations of the motor neuron and pancreas homeobox 1 (MNX1) gene. Familial cases of Currarino triad combined with Mullerian duct anomaly without MNX1 gene mutation are very rare. Here we report cases of mother and daughter, who had Currarino triad and Mullerian duct anomaly without MNX1 gene mutation, along with a brief literature review.
Genes, Homeobox ; Humans ; Mothers* ; Motor Neurons ; Mullerian Ducts ; Nuclear Family* ; Pancreas ; Uterus ; Vagina

PURPOSE: The availability of intraoperative parathyroid hormone (IOPTH) monitoring allows successful focused parathyroidectomy for primary hyperparathyroidism (pHPT). The objective of this study was to report our initial experience in IOPTH monitoring during parathyroid surgery for primary hyperparathyroidsim. METHODS: Between May 2011 and February 2013, 37 patients underwent focused parathyroidectomy due to pHPT. IOPTH monitoring based on Miami criteria was used to confirm complete excision of hyperfunctioning parathyroid gland during surgery. Medical records of patients were reviewed retrospectively. RESULTS: Preoperative mean maximal calcium level was 11.7 ± 0.9 mg/dL. Preoperative technetium (99mTc) sestamibi scan and ultrasonography identified 32 of 37 (86.5%) and 29 of 37 (78.4%) of abnormal parathyroid glands, retrospectively. Results of the 2 imaging modalities were discordant for 8 cases (21.6%). The mean pre-excision PTH level was 147.2 ± 201.5 pg/mL. At 5- and 10-minute post tumor resection, PTH levels were 65.3 ± 25.4 pg/mL and 47.5 ± 24.3 pg/mL, respectively. In all cases, IOPTH levels fell by at least 50% after removing all suspected abnormal glands. All patients had a successful return to normocalcemia after surgery (mean follow-up period: 60.2 ± 15.4 months). CONCLUSION: Surgeon could confirm complete excision of abnormal hyperfunctioning parathyroid glands by IOPTH monitoring during surgery for pHPT. IOPTH monitoring can maximize performance of successful focused para thyroidectomy for pHPT, especially when preoperative imaging results are discordant.
Calcium ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary ; Medical Records ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Retrospective Studies ; Technetium ; Thyroidectomy ; Ultrasonography

PURPOSE: The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool. METHODS: A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis. RESULTS: In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy. CONCLUSION: The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.
Adult ; Aged ; Cough ; Deglutition ; Deglutition Disorders/complications/*diagnosis ; Facial Asymmetry ; Female ; Fluoroscopy/methods ; Humans ; Inhalation ; Male ; Middle Aged ; Risk Assessment ; Stroke/*complications/radiography/therapy

Prader-Willi syndrome is a disease of chromosome 15, which is characterized by severe hypotonia and feeding difficulty in neonates, followed by development of obesity, mental retardation, and hypogonadism. Approximately 70% of the patients have a paternal deletion on chromosome 15q11-13, which is mainly a microdeletion, and a large deletion due to an unbalanced structural translocation of the proximal long arm of chromosome 15 to several other chromosomes is rarely found. We encountered a neonatal case with Prader-Willi syndrome who had sustained hypotonia and feeding difficulty. On high-resolution chromosome analysis, deletion of the short arm and the proximal part of the long arm of chromosome 15, with unbalanced translocation of the remaining part of chromosome 15(q13-qter) to the terminal part q37 of chromosome 2, was shown to be <45,XX, -15, der(2) t(2;15) (q37:q13)>. Through FISH (Fluorescence in situ hybridization) and methylation-specific DNA PCR, we confirmed the deleted q11-13 was derived from the father.
Arm ; Chromosomes, Human, Pair 15 ; Chromosomes, Human, Pair 2* ; DNA ; Fathers ; Humans ; Hypogonadism ; Infant, Newborn ; Intellectual Disability ; Muscle Hypotonia ; Obesity ; Polymerase Chain Reaction ; Prader-Willi Syndrome*

Successful recovery from brain ischemia is limited due to poor vascularization surrounding the ischemic zone. Cell therapy with strong angiogenic factors could be an effective strategy to rescue the ischemic brain. We investigated whether cartilage oligomeric matrix protein (COMP)-Ang1, a soluble, stable and potent Ang1 variant, enhances the angiogenesis of human cord blood derived endothelial progenitor cells (hCB-EPCs) for rescuing brain from ischemic injury. COMP-Ang1 markedly improved the tube formation of capillaries by EPCs and incorporation of EPCs into tube formation with human umbilical vein endothelial cells (HUVECs) upon incubation on matrigel in vitro. COMP-Ang1 stimulated the migration of EPCs more than HUVECs in a scratch wound migration assay. The transplanted EPCs and COMP-Ang1 were incorporated into the blood vessels and decreased the infarct volume in the rat ischemic brain. Molecular studies revealed that COMP-Ang1 induced an interaction between Tie2 and FAK, but AKT was separated from the Tie2-FAK-AKT complex in the EPC plasma membrane. Tie2-FAK increased pp38, pSAPK/JNK, and pERK-mediated MAPK activation and interacted with integrins alphanubeta3, alpha4, beta1, finally leading to migration of EPCs. AKT recruited mTOR, SDF-1, and HIF-1alpha to induce angiogenesis. Taken together, it is concluded that COMP-Ang1 potentiates the angiogenesis of EPCs and enhances the vascular morphogenesis indicating that combination of EPCs with COMP-Ang1 may be a potentially effective regimen for ischemic brain injury salvage therapy.
Angiogenesis Inducing Agents ; Animals ; Blood Vessels ; Brain ; Brain Injuries* ; Brain Ischemia ; Capillaries ; Cartilage Oligomeric Matrix Protein ; Cell Membrane ; Cell- and Tissue-Based Therapy ; Fetal Blood ; Human Umbilical Vein Endothelial Cells ; Humans ; Integrins ; Ischemia ; Morphogenesis ; Rats ; Salvage Therapy ; Stem Cells ; Wounds and Injuries

PURPOSE: A number of researchers have suggested the use of sodium hyaluronate carboxymethyl cellulose (HA-CMC) membrane for preventing postoperative adhesion. This study evaluated the antiadhesive effect and safety of HA-CMC membrane in thyroidectomy for papillary thyroid cancer. METHODS: One hundred sixty-two patients who underwent thyroidectomy were prospectively randomized. In the study group of 80 patients, the 7.5 cm x 13 cm HA-CMC membrane was applied to the operative field after thyroidectomy. The subjects were asked about complications including adhesive symptoms using an 8-item questionnaire at 2 weeks, 3 months, and 6 months after surgery. In addition, items on the appearance of neck wrinkles and scars were evaluated by a physician who had no information about the patient's allocation. RESULTS: There were no significant differences in complications such as swallowing difficulty, and wrinkles between study and control groups. Both groups presented significantly decreased scores over time in swallowing difficulty, and wrinkles. There were no complications regarding the HA-CMC membrane. CONCLUSION: The antiadhesive effect of HA-CMC membrane in thyroid surgery is still uncertain, although it is biologically safe. Further investigation is needed to confirm the antiadhesive effect of HA-CMC membrane in thyroid surgery.
Adhesives ; Carboxymethylcellulose Sodium ; Cellulose* ; Cicatrix ; Deglutition ; Humans ; Hyaluronic Acid ; Membranes* ; Neck ; Prospective Studies ; Surveys and Questionnaires ; Sodium* ; Thyroid Gland* ; Thyroidectomy

Endometriosis, which is the presence of endometrial glands and stroma in extrauterine locations, is a benign gynecologic disease that may cause dysmenorrhea, chronic pelvic pain and infertility. Endometriosis is a relatively common disease that is estimated to occur in 6~10% of reproductive-aged women. Various theories have been proposed regarding the pathogenesis of endometriosis, but a definitive theory remains obscure. Diagnosis of endometriosis in postmenopausal women is rare, but it has been reported in 2~5% of postmenopausal women receiving hormone therapy. However, endometriosis can also occur in postmenopausal women not receiving hormone therapy, altogether indicating the complex pathogenesis of endometriosis. We report left ovarian endometriosis in a postmenopausal woman who had a hysterectomy a uterine myoma 16 years ago and review the relevant literature.
Dysmenorrhea ; Endometriosis ; Female ; Genital Diseases, Female ; Humans ; Hysterectomy ; Infertility ; Menopause ; Myoma ; Pelvic Pain