BACKGROUND: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(DWI) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. METHODS: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(CT), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. RESULTS: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(VB-TIA), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. CONCLUSION: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke.
Brain Stem Infarctions ; Emergencies ; Emergency Service, Hospital ; Humans ; Infarction ; Magnetic Resonance Imaging ; Medical Records ; Reading ; Retrospective Studies ; Risk Factors* ; Sensitivity and Specificity ; Stroke* ; Tomography, X-Ray Computed ; Vertigo*

BACKGROUND: The evaluation of behavioral and psychological symptoms (BPSD) is important for the diagnosis and management of Alzheimer's disease (AD). Previous studies have reported the prevalence and severity of BPSD changes. However, these studies have mainly focused on the AD patients with mild to moderate severity. Our study investigated the BPSD in AD patients with more advanced stages and looked at the prevalence and severity of BPSD with the progression of disease. METHODS: One hundred thirty six patients with probable AD received the Korean version of the neuropsychiatric inventory along with the expanded version of the Korean Clinical Dementia Rating Scale (CDR) and the Korean version of the Mini-Mental State Examination (K-MMSE). RESULTS: The mean K-MMSE, CDR and NPI scores were 10.1 (SD=7.1), 2.0 (SD=1.5) and 32.7 (SD=26.2), respectively. CDR and K-MMSE scores did not correlate with the total NPI score but did correlate with some of the subscale NPI scores. Apathy had the highest relationship to CDR (r=0.39, p<0.01). Aberrant motor was most correlated with the total score of NPI (r=0.65, p<0.01). The mean number of positive NPI items was 4.3, which ranged from 2.1 (CDR 5 group) to 5.4 (CDR 2 group). The most frequent symptom was apathy and the least was euphoria. The severity of BPSD increased as the dementia severity increased to CDR 2 except apathy. Night-time behavior and anxiety were frequent in the early stages whereas apathy and aberrant motor were frequent symptoms in later stages. CONCLUSIONS: These observations suggest that BPSD is relatively independent of cognitive functions. The prevalence and severity of BPSD with the exclusion of apathy, increased as the dementia severity increased from CDR 0.5 to CDR 2 and then declined declined except apathy.
Alzheimer Disease* ; Anxiety ; Apathy ; Dementia ; Diagnosis ; Euphoria ; Humans ; Prevalence

Leiomyoma is an uncommon lesion which may originate anywhere including the genitourinary system where smooth muscle is present. Five cases of leiomyoma of the testicular tunica albuginea were reported in the world literature. A case of leiomyoma of testicular tunica albuginea in a 58 year old male is presented. We preserved the testis with tumor resection. This is the first report of leiomyoma of testicular tunica albuginea in Korea.
Humans ; Korea ; Leiomyoma* ; Male ; Middle Aged ; Muscle, Smooth ; Testis ; Urogenital System

Spontaneous extrahepatic rupture of hepatocellular carcinoma (HCC) is a rare but serious complication that occurs with an incidence of between 5 and 15% of patients with HCC. It is thought to be preceded by rapid expansion due to intratumoral bleed-ing. Extrahepatic rupture of HCC has been reported as a rare complication of tran-scatheter arterial embolization (TAE). Although there have been reports of extrahepatic rupture of HCC after TAE, but there is no report regarding intratumoral hemor-rhage into HCC during TAE. We report a unique case of intratumoral hemorrhage into HCC during TAE presumably triggered by TAE. Although a rare complication, intratumoral hemorrhage into HCC after TAE should be considered in any patient with TAE due to HCC.
Carcinoma, Hepatocellular/*blood supply ; Catheterization/*adverse effects ; Embolization, Therapeutic/*adverse effects ; Hemorrhage/*diagnosis/*etiology ; Humans ; Liver Neoplasms/*blood supply ; Male ; Middle Aged ; Rupture, Spontaneous/diagnosis/etiology

Trichobezoars are gastric concretions that are composed of hair or fibers. They are more common in children and adolescents and are usually associated with a pica, emotional disturbance, or mental retardation. Trichobezoar is quite rare in Korea. In most cases, trichobezoars tend to form a cast of the stomach. However, in rare cases, portions of the trichobezoar may separate from the gastric mass, migrate distally, and obstruct the small bowel. We report a case of small bowel obstruction due to multiple trichobezoars in a 14 year-old-girl who had a habit of swallowing hairs until 12 years of age. The patient was treated successfully surgically.
Adolescent ; Affective Symptoms ; Bezoars* ; Child ; Deglutition ; Hair ; Humans ; Intellectual Disability ; Korea ; Pica ; Stomach

BACKGROUND: Vascular ring is a rare anomaly of the aortic arch. We did surgical repair procedures on 16 cases of vascular ring over the past 12 years. This article reviews our results. MATERIAL AND METHOD: Between 1995 and 2007, 16 patients (5 with double aortic arch, 7 with right aortic arch-left ligamentum, 4 with pulmonary artery sling) underwent surgical repair. Mean age at the time of the operation were as follows: double aortic arch, 5.7+/-5.5 years; right aortic arch-left ligamentum, 6.1+/-13.4 years; pulmonary artery sling, 2.9+/-2.6 years. Five patients (71%) with right aortic arch-left ligamentum had an associated Kommerell's diverticulum. Two patients (40%) with double aortic arch, 2 patients (28.6%) with right aortic arch-left ligament and 4 patients (100%) with pulmonary artery sling had associated airway stenosis. Cardiac anomalies were present in 8 of 16 patients. RESULT: There was no peri-operative or post-operative mortality. The mean hospital stay was 27.1+/-38.2 days. None of our patients underwent reoperation. CONCLUSION: Vascular ring is rare, but, it needs surgical correction. It is important to suspect the diagnosis and to validate with echocardiography. Preoperative and postoperative computed tomography and bronchoscopy are useful to evaluate the airway and surrounding structures.
Aorta, Thoracic ; Bronchoscopy ; Constriction, Pathologic ; Diverticulum ; Echocardiography ; Humans ; Length of Stay ; Ligaments ; Pulmonary Artery ; Reoperation ; Tracheal Stenosis

OBJECTIVES: This study was to develop effective managements and to avoid the abuse of human rights in mentally-ill patients. The Mental Health Judgement Board of Chungchongbuk-do province has been held monthly since August, 1997 according to the Mental Health Act. In this study, the procedures and the problems of judging continuing hospitaliztion of chronic mentally-ill patients were reviewed. METHODS: The mentally-ill patients who submitted the request for continuing hospitalization with the certificate of charged doctor and the agreement of caregiver were reviewed by the Mental Health Judgement Board of Chungchongbuk-do province. The analysis of the diagnoses, caregivers, medical care systems, and rejection rate for the patients were done. RESULTS: Total mumber of mentally-ill patients who requested for continuing hospitalization were 7,981 from twenty-one monthly meetings. The diagnostic distributions were 80.9% for schizophrenic patients, 8.1% for alcoholics and 11.0% for others including dementia. As for the caretakers, the rate of majors was 29.8%, parents 26.9%, sibling 26.1%, spouse 6.3%, offspring 5.9%, and others 5.0%. And 73.0% of the patients were on Medicaid and 27.0% were insured. The patients who got the rejection for continuing hospitalization were 196 at the rate of 2.46%. And the rejection rates of schizophrenic and alcoholic patients were 0.73% and 17.6%, respectively. CONCLUSIONS: New policies for decreasing longterm hospitalization of chronic mentally-ill patients are required. And the social support systems for psychiatric rehabilitation and readjustment are presently insufficient for the already discharged mentally-ill. Moreover, the practical guidelines for human rights of patients remains to be suggested.
Alcoholics ; Caregivers ; Dementia ; Diagnosis ; Hospitalization* ; Human Rights ; Humans ; Medicaid ; Mental Health ; Parents ; Rehabilitation ; Siblings ; Spouses