Vascular dementia is one of the few remediable causes of dementia among the eldery. Prevention of the disease can be best achieved by primary or secondary prevention of controllable risk factors for strokes. Therefore, early and accurate diagnosis of vascular cognitive impairment prior to the dementia stage is essential to the prevention and treatment of vascular dementia. Pharmacological and non-pharmacological methods for prevention of vascular dementia are listed in this article. Recent epidemiologic data, suggesting a direct correlation between vascular risk factors and Alzheimer type dementia, emphasized the importance of controlling vascular risk factors in the prevention of dementia. Treatment strategies for patients diagnosed as vascular dementia are also discussed. Several clinical trials for symptomatic improvement of vascular dementia are ongoing and their success can be a hope to patients with vascular dementia.
Alzheimer Disease ; Cognition Disorders ; Dementia ; Dementia, Vascular* ; Diagnosis ; Hope ; Humans ; Risk Factors ; Secondary Prevention ; Stroke

No abstract available.
Abdominal Cavity* ; Abscess* ; Atrial Natriuretic Factor* ; Drainage*

No abstract available.
Fournier Gangrene* ; Scrotum* ; Sparganosis*

RATIONALE: Studies on ictal SPECT as a method of presurgical evaluation in neocortical epilepsy have been rare and inadequate. We evaluated the accuracy in the localization of epileptic foci with ictal SPECT in neocortical epilepsy and tried to find out the determining factors of its accuracy. METHODS: We performed ictal SPECT 66 times with 99m-Tc-HMPAO in 56 patients, who received video-EEG monitoring and had electroclinical features of neocortical epilepsy. Invasive monitoring was performed in 28 patients & epileptic surgery was done in 31. Their results were also used to help determine the location of epileptic foci. In 54 of 66 scans data about injection time and temporal relationship of HMPAO injection to the onset and secondary generalization of seizures were available. RESULTS: Frontal lobe epilepsy(FLE) was most common(35%) followed by lateral temporal lobe epilepsy(28%), occipital lobe epilepsy(11%), parietal lobe epilepsy(9%), and etc. Ictal SPECT demonstrated unilateral hyperperfusion in 53 of 66 scans (80.3 %) which were concordant with electroclinical lateralization in 48 of 53 (90.6 %). Localized hyperperfusion was evident in 42 of 66 scans (63.6 %) which were concordant with electroclinical localization in 33 of 42(78.6 %). Correctly localized hyperperfusion or correctly-lateralized but diffuse hyperperfusion were detected in 37 of 54 scans in which data about injection time were available. The mean injection time was 32.1 seconds. In 16 scans ictal SPECT showed no hyperperfusion or falsely localized/lateralized hyperperfusion. Their mean injection time was 41.6 seconds. The difference of injection time between two groups was not significant(p-value=0.07), but there was a tendency that the mean injection time of the former group was earlier than that of the latter group. We had chances to perform ictal SPECT repeatedly in 8 patients under the similar conditions. The fact that earlier injection improved the accuracy of ictal SPECT in 6 patients supports the importance of early injection. In 48 studies with ictal injection, only 11 scans gave no or incorrect information of the localization or lateralization of epileptic foci. But, in 6 studies with postictal injection, 5 scans was not helpful. The difference between two groups was statistically significant(p<0.05). The presence of focal lesion, the location of epileptic foci, or secondary generalization did not influence the accuracy of ictal SPECT. CONCLUSIONS: Our data suggest that ictal SPECT in neocortical epilepsy is useful in localization of epileptic foci. Whether injected ictally or postictally and the injection time from seizure onset seems to influence the accuracy of ictal SPECT in neocortical epilepsy.
Epilepsy ; Frontal Lobe ; Generalization (Psychology) ; Humans ; Occipital Lobe ; Parietal Lobe ; Seizures ; Technetium Tc 99m Exametazime ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

Serous cystadenoma of the pancreas, also known as microcystic adenoma or glycogen-rich cystadenoma, is an unusually benign tumor. It is usually large and composed microscopically of many small cysts lined by small, cuboidal or flattened cells containing abundant glycogen. It has been suggested that serous cystadenoma probably arise from the ductular cells or centroacinar cells. Herein, we report on a case of serous cystadenoma of the pancreas in a 55-year-old female. The tumor, measuring 13.5x11.5x10.0 cm, was located in the head of the pancreas and the cut surface revealed a sponge-like appearance due to innumerable tiny cysts containing clear serous fluid. Microscopic analysis showed cystic spaces lined by cuboidal cells with intracytoplasmic glycogen.
Female ; Humans ; Cysts ; Adenoma

BACKGROUND: It has been reported that organized inpatient (stroke unit) care reduces the mortality rate, and the need for institutional care or dependent living after stroke. Based on this evidence, stroke units have becomes popular among large-scale hospitals in developed countries. The aim of this study was to provide perspective regarding the efficacy of stroke units and their current status in developed countries. Methods and RESULTS: An electronic search was conducted using the Cochrane Database, PubMed, and other online databases, in addition to a manual search. The efficacy of stroke-unit care compared to general-ward care was summarized and is presented with respect to death, death or institutional care, and death or dependency by the end of the scheduled follow-up. Current concepts and the status of stroke-unit services among developed countries were reviewed and compared with each other. The desirable models of stroke-unit services are discussed in terms of the stroke center. CONCLUSIONS: Stroke is the second leading cause of death in Korea and there that stroke-unit care is effective at improving the outcome of stroke patients. The expeditious development and realization of organized inpatient care for stroke victims should be a Government priority.
Cause of Death ; Dependency (Psychology) ; Developed Countries ; Electronics ; Electrons ; Follow-Up Studies ; Humans ; Inpatients ; Korea ; Stroke

BACKGROUND & OBJECTIVES: Subacute combined degeneration (SCD) is a disease of spinal cord involving the posterior and lateral column due to vitamin B12 deficiency. The clinical and electrophysiologic findings of SCD are various. METHODS: From 1989 to 1996, 7 patients were diagnosed with SCD in our hospitals. The diagnosis was made by the neurologic and laboratory findings and electrophysiolgic studies such as nerve conduction studies(NCS) and evoked potential(EP). RESULT: Four patients received gastrectomy. Two had chronic atrophic, gastritis; one of them was assumed to have food-cobalamin malabsorrtion. The remaining one was a heavy drinker. The mean duration of neurologic symptoms was 35.7 months. The most common initial complaint was paresthesia (in 4) and impairment of cutaneous sensation was the most common neurologic sign At the time of diagnosis, 5 patients had myelopathy with was supported by EP in 3(60%). There were abnormal NCS findings in 5 f 6 patients with peripheral neuropathy. In one patient, there was no symptom and sign compatible with myelopathy but median nerve SEP showed bilateral central conduction delay. No one had visual symptoms but prolongation of P 100 was detected in 2 patients. Sural nerve biopsy was done in 2 case, which revealed chronic nonspecific neuropatby in one and chronic axonopathy in the other. Megaloblastic anemia was found in 4 cases and improved by cobalamin therapy in all the parents, in which the follow up hematologic data were available. There as a tendency that nonanemic patients had more severe neurologic symptoms than anemic ones. We could not find any relationship between the duration and severity of neurologic menifestations was best in the patients with the shortest duration of neurologic manifestations and hematologic feature festations. CONCLUSIONS: The authors suggest that early detection and treatment is very important for the improvement of symptoms in SCD.
Anemia, Megaloblastic ; Biopsy ; Diagnosis ; Follow-Up Studies ; Gastrectomy ; Gastritis ; Humans ; Median Nerve ; Neural Conduction ; Neurologic Manifestations ; Parents ; Paresthesia ; Peripheral Nervous System Diseases ; Sensation ; Spinal Cord ; Spinal Cord Diseases ; Subacute Combined Degeneration* ; Sural Nerve ; Vitamin B 12 ; Vitamin B 12 Deficiency

PURPOSE: We evaluated the long-term outcome of the Gittes procedure for treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 84 women had Gittes bladder neck suspension carried out for the treatment of anatomic stress urinary incontinence. Long term (mean 51.4 months) results were evaluated using a questionnaire. RESULTS: Of the 58 patients assessed, 25 (43.1%) reported cure of stress urinary incontinence, 19 (32.8%) reported improvement, 12 (20.7%) were the same and 2 (3.4%) were worse after Gittes bladder neck suspension. Thirty-seven (63.8%) replied 'satisfactory' for the Gittes bladder neck suspension. Overall success rate was estimated as 62.1%. Depending on follow-up periods success rate was declined with time and by 5 years the success rate was 67.2%. CONCLUSIONS: Although the Gittes procedure was quick and easy to perform and was well tolerated with minimal complications, long term follow-up study of Gittes bladder neck suspension showed a declining success rate with time. Therefore it may not be a satisfactory procedure for the management of anatomic stress urinary incontinece in women.
Female ; Follow-Up Studies ; Humans ; Neck ; Surveys and Questionnaires ; Urinary Bladder ; Urinary Incontinence*

BACKGROUND : Till now, several studies advocated the vascular etiology as a cause of acute isolated vertigo without relevant lesions on magnetic resonance imaging (MRI). However, most of them were case series and ,even in a few case-control studies, inclusion criteria were obscure and vascular risk factors were not considered. OBJECTIVES: To investigate the clinical significance of vertebrobasilar artery (VBA) pathology in acute isolated vertigo without relevant lesions on MRI. Methods : 84 patients (26 male, 59 female; 62.5+/-0.2 years) with acute isolated vertigo who had no lesions on MRI were gathered. Seventy nine controls (30 male, 49 female; 58.4+/-0.1 years) consisted of subjects with clinically definite BPPV, epilepsy, tension headache, or lacunar infarction. All the subjects underwent MRI and magnetic resonance angiography (MRA). The vascular pathology of VBA and anterior circulation were examined and graded by the findings of MRA. Focal stenosis more than 50%, non- or faint-visualization, or dolichoectasia of VBA were regarded as significant. Risk factors of atherosclerosis were investigated and the severity of small vessel disease on MRI were ranked. RESULTS : Significant vascular pathology of VBA was found more frequently in patients with acute isolated vertigo (32.1%) than in controls (16.5%) (p<0.05). Among the risk factors of atherosclerosis, hypertension was more common in patients (44.0%) than in controls (29.1%) (p<0.05) and the others were not different between two groups. Significant vascular pathology of anterior circulation and SVD were not different, too (fP>0.05). Multivariate analysis including all the possible variables investigated confirmed the significant correlation between VBA pathology and acute isolated vertigo in our subjects (p<0.05). CONCLUSION : This study demonstrates that there is a signficant correlation between VBA pathology and acute isolated vertigo without lesions on MRI. It can support the importance of VBA pathology as a a cause of acute isolated vertigo.
Arteries ; Atherosclerosis ; Case-Control Studies* ; Constriction, Pathologic ; Epilepsy ; Female ; Humans ; Hypertension ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Multivariate Analysis ; Pathology* ; Risk Factors ; Stroke, Lacunar ; Tension-Type Headache ; Vertigo*

BACKGROUND: Knowing the magnitude of a problem is the first step to improving it, and quantifying the health- related quality of life (HRQOL) allows us to do it with respect to stroke. To identify the HRQOL in patients with ischemic stroke and its affecting factors, and compare it with other clinical and functional scales. METHODS: A consecutive series of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) was recruited. Their HRQOL and utilities were assessed using the EQ-5 Dindex-which evaluates the health profile of an individual in five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression) and three levels (no problem, some/moderate problems, and extreme problems)-at 1 year after stroke. The Modified Rankin Scale (MRS), Barthel Index (BI), and NIH Stroke Scale (NIHSS) were used to measure clinical and functional statuses. The EQ-5D index and the clinical and functional statuses were compared by clinical parameters, and the relationships among those scales were examined. Additionally, the EQ-5D index in the patients was compared with that in age- and sex-matched healthy controls. RESULTS: Among 538 patients with AIS or TIA, 465 patients (males, 59.8%; age, 65.3+/-11.8 [mean+/-SD]; TIA, 7.7%; and initial NIHSS, 4.5+/-5.1) were evaluated. The EQ-5D index and the clinical and functional statuses were clearly aggravated by age, but did not differ with most of the risk factors. The EQ-5D index was strongly and significantly correlated with scores on the MRS, BI, and NIHSS. The EQ-5D index was lower in patients (especially older ones) than in healthy controls. CONCLUSIONS: This study shows that the EQ-5D is a feasible and valid tool for measuring HRQOL in patients with AIS or TIA.
Humans ; Ischemic Attack, Transient ; Quality of Life ; Resin Cements ; Risk Factors ; Self Care ; Stroke ; Weights and Measures