PURPOSE: Either gated myocardial perfusion SPECT or attenuation corrected SPECT can be used to improve specificity in the diagnosis of coronary artery disease. We investigated in this study whether gating or attenuation correction improved diagnostic performance of rest/stress perfusion SPECT in patients having intermediate pre-test likelihood of coronary artery disease. MATERIALS AND METHODS: Sixty-eight patients underwent rest attenuation-corrected T1-20l/dipyridamole stress gated attenuation-corrected Tc-99m-MIBI SPECT using an ADAC vertex camera (M:F=29:39, aged 59+/-12 years, coronary artery stenosis> or =70%. one vessel: 13, two vessel: 18, three vessel: 8, normal: 29). Using a five-point scale, three physicians graded the post-test likelihood of coronary artery disease for each arterial territory (1 normal, 2: possibly normal 3:equivocal, 4: possibly abnormal, 5: abnormal). Sensitivity, specificity and area under receiver-operating-characteristic curves were compared for each operator between three METHODS: (A) non-attenuation-corrected SPECT; (B) gated SPECT added to (A); and (C) attenuation-corrected SPECT added to (B). RESULTS: When grade 3 was used as the criteria for coronary artery disease, no differences in sensitivity and specificity were found between the three methods for each operator Areas under receiver- operating-characteristic curves for diagnosis of coronary artery disease revealed no differences between each modality (p>005). CONCLUSION: In patients at intermediate risk of coronary artery disease, gated SPECT and attenuation-corrected SPECT did not improve diagnostic performance.
Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Perfusion* ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: This questionnaire study was conducted to examine sexual problems and assess the effect of sexual rehabilitation education on the marital intimacy in patients with spinal cord injuries. MATERIALS AND METHODS: 45 male patients with spinal cord injuries were evaluated for sexual problems using a questionnaire. The patients were divided into two groups: control group (n=16) and trial group (n=16). Sexual rehabilitation education for patients, using manual and video tapes, was provided. The effect of sexual rehabilitation education on marital intimacy was assessed in the two groups. Using Student's t-test (paired), Student's t-test the scores of marital intimacy measured before and after the sexual rehabilitation education were compared. RESULTS: After one year, 80% (36/45) of the subjects recovered normal sexual desire, and 51% (23/45) recovered normal erectile function, most of who had been proved to have sustained a spinal cord injury at the cervical or thoracic level. Normal erectile function was more frequently seen in patients with incomplete spinal cord injury than in those with complete spinal cord injury. 31% (14/45) were able to ejaculate and 29% (13/45) experienced orgasm. After sustaining a spinal cord injury, 87% (39/45) were aware of sexual rehabilitation education. However, only 13% (5/45) were informed by their healthcare professionals. After sexual rehabilitation education, a significant increase in marital intimacy was found in the trial compared to the control group. CONCLUSIONS: In conclusion, our results indicate that sexual rehabilitation education is effective at increasing the marital intimacy of patients with a spinal cord injury. Moreover, these patients must receive relevant care and education from their healthcare professionals, which must also be in a persistent manner.
Delivery of Health Care ; Education* ; Humans ; Male* ; Orgasm ; Surveys and Questionnaires ; Rehabilitation* ; Spinal Cord Injuries ; Spinal Cord*

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited familial tumor syndrome. Benign tumors such as pilocytic astrocytoma, optic glioma make up the majority of intracranial neoplasms in patients with NF1. There have only been a handful of cases in which adult glioblastoma presented with NF1. A 32-year-old male presented with headache and radiological studies showing a high grade intra-axial tumor. The patient underwent gross total surgical excision and the pathology revealed glioblastoma. After the surgery, he received concomitant chemo-radiotherapy with temozolomide and adjuvant temozolomide chemotherapy. We report a NF1 patient who developed glioblastoma and reviewed related articles.
Adult ; Astrocytoma ; Brain Neoplasms ; Drug Therapy ; Glioblastoma* ; Hand ; Headache ; Humans ; Male ; Neurofibromatosis 1* ; Optic Nerve Glioma ; Pathology

BACKGROUND: Since the first introduction of radioimmunoassay for the quantification of the thyroidstimulating hormone (TSH), more advanced analytical methods have been developed and used in laboratories. However, they are still inconvenient in that they require time-consuming procedures, special safety in handling isotopes, expensive equipment, and a highly qualified expert. METHODS: As an immunoassay system for the rapid measurement of TSH in serum, we have developed a new analytical system based on immunochromatographic assay with fluorescencelabeled anti-TSH monoclonal antibodies. The assay system is composed of a test strip housed within a cartridge and a laser-fluorescence scanner for quantification. The strip contains a sample pad, an absorption pad, and a nitrocellulose membrane where a captured antibody is immobilized and antigen-antibody reaction occurs. Fifty microL of serum was added to 50 microL of a detector solution and the mixture was loaded onto the well of the sample pad on the cartridge. After incubation for 12 min, the cartridge was quantified with the laser-fluorescence scanner. RESULTS: The calibration curve displayed linearity (R=0.95) at concentrations of 1-40 mIU/L. Intraand inter-assay imprecisions were determined to be CVs within 10%. Analytical recovery was 93.9% at 3 different concentrations and the detection limit was 0.868 mIU/L of TSH. The new assay system correlated well with an Abbott AxSYM for quantification of TSH (R=0.97, slope 0.94, N=20). CONCLUSIONS: The TSH measurement system developed in this study showed good reproducibility. However, our TSH quantification system needs some improvement to be used in the medical field because of its low analytical sensitivity. With enhanced performance in analytical sensitivity, introduction of a whole-blood type strip, and a more miniaturized fluorescence scanner, we expect the TSH analytical system to be used for point-of-care testing in the near future.
Absorption ; Antibodies, Monoclonal ; Antigen-Antibody Reactions ; Calibration ; Collodion ; Fluorescence* ; Immunoassay ; Immunochromatography* ; Isotopes ; Limit of Detection ; Membranes ; Radioimmunoassay ; Thyrotropin*

Craniopharyngiomas exhibiting histologic malignancy are extremely rare. Herein, we report the case of a 26-year-old male patient who underwent suprasellar mass excision via an interhemispheric transcallosal approach. Histopathological examination indicated that the craniopharyngioma was of the adamantinomatous subtype. The patient received postoperative medical treatment for endocrine dysfunction and diabetes mellitus without radiation treatment. Two years after the operation, he presented with progressive visual disturbance and altered mentality. Magnetic resonance imaging revealed a huge mass in the suprasellar cistern and third ventricle. He underwent a second operation via the same approach. The histopathological examination showed an adamantinomatous craniopharyngioma with sheets of solid proliferation in a spindled pattern, indicating malignant transformation. Malignant transformation of craniopharyngioma in the absence of radiation therapy has been reported in only five cases, including this one. We present a case of malignant transformation of craniopharyngioma with a brief review of relevant literature.
Adult ; Craniopharyngioma* ; Diabetes Mellitus ; Humans ; Magnetic Resonance Imaging ; Male ; Radiotherapy ; Third Ventricle

OBJECTIVE: This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system.METHODS: This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed.RESULTS: Of the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p < 0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06).CONCLUSION: Surveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.
Bacteria ; Craniotomy ; Gram-Negative Bacteria ; Humans ; Incidence ; Korea ; Length of Stay ; Logistic Models ; Multivariate Analysis ; Neurosurgery ; Neurosurgical Procedures ; Observational Study ; Prospective Studies ; Risk Factors ; Serratia marcescens ; Staphylococcus aureus ; Surgical Wound Infection ; Ventriculoperitoneal Shunt

OBJECTIVE: This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following spinal surgery using data from a Korean SSI surveillance system that included diagnoses made by surgeons.METHODS: This was a prospective observational study of patients who underwent spinal surgeries at 42 hospitals in South Korea from January 2017 to December 2017. The procedures included spinal fusion, laminectomy, discectomy, and corpectomy. Univariate and multivariate logistic regression analyses were performed.RESULTS: Of the 3080 cases included, 30 showed infection, and the overall SSI rate was 1.0% (an incidence of 1.2% in spinal fusion and 0.6% in laminectomy). Deep incisional infections were the most common type of SSIs (46.7%). Gram-positive bacteria caused 80% of the infections, and coagulase-negative staphylococci, including Staphylococcus epidermidis, accounted for 58% of the gram-positive bacteria. A longer preoperative hospital stay was significantly associated with the incidence of SSI after both spinal fusion and laminectomy (p=0.013, p < 0.001). A combined operation also was associated with SSI after laminectomy (p=0.032).CONCLUSION: An SSI surveillance system is important for the accurate analysis of SSI. The incidence of SSI after spinal surgery assessed by a national surveillance system was 1.0%. Additional data collection will be needed in future studies to analyze SSI in spinal surgery.
Data Collection ; Diagnosis ; Diskectomy ; Gram-Positive Bacteria ; Humans ; Incidence ; Korea ; Laminectomy ; Length of Stay ; Logistic Models ; Observational Study ; Prospective Studies ; Risk Factors ; Spinal Fusion ; Spine ; Staphylococcus epidermidis ; Surgeons ; Surgical Wound Infection

Objective: : Deep learning is a machine learning approach based on artificial neural network training, and object detection algorithm using deep learning is used as the most powerful tool in image analysis. We analyzed and evaluated the diagnostic performance of a deep learning algorithm to identify skull fractures in plain radiographic images and investigated its clinical applicability. Methods: : A total of 2026 plain radiographic images of the skull (fracture, 991; normal, 1035) were obtained from 741 patients. The RetinaNet architecture was used as a deep learning model. Precision, recall, and average precision were measured to evaluate the deep learning algorithm’s diagnostic performance. Results: : In ResNet-152, the average precision for intersection over union (IOU) 0.1, 0.3, and 0.5, were 0.7240, 0.6698, and 0.3687, respectively. When the intersection over union (IOU) and confidence threshold were 0.1, the precision was 0.7292, and the recall was 0.7650. When the IOU threshold was 0.1, and the confidence threshold was 0.6, the true and false rates were 82.9% and 17.1%, respectively. There were significant differences in the true/false and false-positive/false-negative ratios between the anteriorposterior, towne, and both lateral views (p=0.032 and p=0.003). Objects detected in false positives had vascular grooves and suture lines. In false negatives, the detection performance of the diastatic fractures, fractures crossing the suture line, and fractures around the vascular grooves and orbit was poor. Conclusion : The object detection algorithm applied with deep learning is expected to be a valuable tool in diagnosing skull fractures.

The aim of this study was to analyze long-term survivals in patients with stage IB to IIA cervical cancer treated by neoadjuvant chemotherapy setting. Between February 1989 and January 1998, 94 women with previously untreated stage IB to IIA carcinoma of the uterine cervix who received cisplatin based neoadjuvant chemotherapy were enrolled in this study. All of patients with chemoresponse (complete response, n=15; partial response, n=47) and 16 patients with chemoresistance received radical surgery (RS group). The other 16 patients with chemoresistance received radiotherapy for definite treatment (RT group). In the RS group, the 10 yr survival estimation in patients with bulky tumors (diameter > or =4 cm, n=26) was similar to that with non-bulky tumors (83.3% vs. 89.3%, p=NS). In selected patients with chemoresistance, those treated by radiotherapy (n=16) showed significantly poorer survivals than those treated by radical surgery (n=16) [10 yr survival rates of RT (25%) vs. RS (76.4%), p=0.0111]. Our results support that a possible therapeutic benefit of neoadjuvant chemotherapy plus radical surgery is only in patients with bulky stage IB to IIA cervical cancer. In cases of chemoresistance, radical surgery might be a better definite treatment option.
Uterine Cervical Neoplasms/drug therapy/*radiotherapy/*surgery ; Treatment Outcome ; Survival Analysis ; Retrospective Studies ; Prognosis ; Neoplasm Staging ; Multivariate Analysis ; Middle Aged ; Humans ; Follow-Up Studies ; Fluorouracil/administration & dosage ; Female ; Drug Resistance, Neoplasm ; Combined Modality Therapy ; Cisplatin/administration & dosage ; Chemotherapy, Adjuvant ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Adult

The Arnold-Chiari type I malformation has many symptoms such as headache, neck pain, gait impairment, abnormal movements or postures. But a few cases reported association of specific symptom including headache, neck pain, vertigo or ataxia. We report a case of 12 year-old boy presenting with tip-toe gait. Magnetic resonance imaging (MRI) study of brain and spine revealed underlying Arnold-Chiari type I malformation. This case shows that it is need for central nervous system evaluation in patients with changes of lower extremities tone.
Ataxia ; Brain ; Central Nervous System ; Dyskinesias ; Gait ; Headache ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Neck Pain ; Posture ; Spine ; Vertigo