No abstract available.
Amnesia, Transient Global* ; Posterior Leukoencephalopathy Syndrome*

PURPOSE: We investigated the value of an interferon-gamma release assay (IGRA) for the diagnosis of active pulmonary tuberculosis (PTB) among sputum smear negative PTB suspects in an environment with intermediate burden of PTB and high Bacillus Calmette-Guerin (BCG) vaccination rate. MATERIALS AND METHODS: We retrospectively reviewed IGRA, medical records, chest PA and CT scan of PTB suspects seen at Gangnam Severance Hospital, Seoul, Korea from Oct. 2007 to Apr. 2013. "Active PTB" was diagnosed when 1) M. tuberculosis culture positive, 2) confirmation by pathologic examination; or 3) clinical findings compatible with TB. RESULTS: Of 224 sputum smear negative PTB suspects, 94 were confirmed as having active PTB. There were no statistically significant differences in the diagnostic yield of IGRA between immunocompromised and immunocompetent sputum smear negative PTB suspects. IGRA did show superior sensitivity [81.9%, 95% confidence interval (CI); 74.13-89.70%] in the diagnosis of sputum smear negative PTB when compared with chest high-resolution computed tomography (HRCT), tuberculin skin test (TST), and chest X-ray (p<0.001). Also, IGRA showed highest negative predictive value (82.7%, 95% CI; 75.16-90.15%) when compared with HRCT, TST and chest X-ray (p=0.023). However, combining the results of IGRA with those of HRCT, TST, or both did not increase any diagnostic parameters. CONCLUSION: Failure to increase diagnostic yields by combination with other diagnostic modalities suggests that additional enforcement with IGRA may be insufficient to exclude other diagnoses in sputum smear negative PTB suspects and to screen active PTB in an environment with intermediate TB prevalence and a high BCG vaccination rate.
Adult ; Aged ; Female ; Humans ; Interferon-gamma Release Tests/*methods ; Male ; Middle Aged ; Retrospective Studies ; Sputum/*microbiology ; Tuberculosis, Pulmonary/blood/*diagnosis/metabolism

BACKGROUND AND OBJECTIVES: Burning mouth syndrome (BMS) refers to a collection of symptoms of patients who complain about burning sensation of their mouths without any specific causes. Although this is not a rare disease, the etiology and effective treatment are not well established. We tried to compare the efficacy and side effects of the agents that are reported to be relatively effective to BMS. SUBJECTS AND METHOD: Fifty-one patients who were diagnosed as BMS were chosen as candidates. Trazodone, Paroxetine, Clonazepam, and Gabapentin, which were known to be effective medicines for BMS in previous research were prescribed randomly. We prescribed medication for two weeks and evaluated patients for the effect and side effects at the end of the treatment. The medication was prescribed for 2 more weeks and the patients were evaluated again. RESULTS: Three of 11 (27.3%) patients were prescribed Trazodone, 8 of 12 (66.7%) Paroxetine, 8 of 14 (57.1%) Clonazepam and 12 of 14 (85.7%) Gabapentin. Q showed improvements after 4 weeks of medication. The differential effectiveness among the medications was not significant, except for the inferiority of Trazodone. Five of 11 (45.5%) patients who had been prescribed Trazodone, 2 of 12 (16.7%) who had been prescribed Paroxetine, 2 of 14 (14.3%) who had been prescribed Clonazepam, 2 of 14 (14.3%) who had been prescribed Gabapentin complained of side effects during 4 weeks of medication. CONCLUSION: We can expect high success rates of treatment for burning mouth syndrome with Paroxetine, Clonazepam and Gabapentin. A further study for long term outcomes and side effects in large groups is warranted.
Amines ; Burning Mouth Syndrome ; Burns ; Clonazepam ; Cyclohexanecarboxylic Acids ; gamma-Aminobutyric Acid ; Humans ; Mouth ; Paroxetine ; Rare Diseases ; Sensation ; Trazodone

OBJECTIVE: To examine the safety and effectiveness of cardiac rehabilitation on patients resuscitated from cardiac arrest due to acute myocardial infarction. METHODS: The study included 23 subjects, including 8 with history of cardiac arrest and 15 without history of cardiac arrest. Both groups underwent initial graded exercise test (GXT) and subsequent cardiac rehabilitation for 6 weeks. After 6 weeks, both groups received follow-up GXT. RESULTS: Statistically significant (p<0.05) increase of VO2peak and maximal MVO2 but significant (p<0.05) decrease of submaximal MVO2 and resting heart rate were observed in both groups after 6 weeks of cardiac rehabilitation. An increasing trend of maximal heart rates was observed in both groups. However, the increase was not statistically significant (p>0.05). There was no statistically significant change of resting heart rate, maximal heart rate, maximal MVO2, or submaximal MVO2 in both groups after cardiac rehabilitation. Fatal cardiac complications, such as abnormal ECG, cardiac arrest, death or myocardial infarction, were not observed. All subjects finished the cardiac rehabilitation program. CONCLUSION: Improvement was observed in the exercise capacity of patients after aerobic exercise throughout the cardiac rehabilitation program. Therefore, cardiac rehabilitation can be safely administered for high-risk patients with history of cardiac arrest. Similar improvement in exercise capacity can be expected in patients without cardiac arrest experience.
Electrocardiography ; Exercise ; Exercise Test ; Follow-Up Studies ; Heart Arrest* ; Heart Rate ; Humans ; Myocardial Infarction* ; Rehabilitation*

Mucinous adenocarcinoma arising from a chronic anorectal fistula is a rare condition. It is often confused with a hemorrhoid or perineal abscess, which consequently delays accurate diagnosis. Here, we report the case of a 58-year-old man with blood-tinged stool who reported a rectal mass, which was diagnosed as mucinous adenocarcinoma arising from an anal fistula. After initial computed tomography-guided needle aspiration biopsy had failed to provide an accurate diagnosis, transrectal punch biopsy was performed to obtained adequate tissue sample for confirmative histological diagnosis. The patient was successfully treated with neoadjuvant concurrent chemoradiotherapy followed by surgical intervention.
Abscess ; Adenocarcinoma, Mucinous* ; Biopsy* ; Biopsy, Needle ; Chemoradiotherapy* ; Fistula* ; Hemorrhoids ; Humans ; Middle Aged ; Mucins* ; Needles ; Neoadjuvant Therapy ; Rectal Fistula

OBJECTIVE: To confirm the improvement in arterial endothelial function by aerobic exercise training, flow-mediated dilation (FMD) was tested by ultrasonography. METHODS: Patients who received percutaneous coronary intervention due to acute coronary syndrome were included. The patients who participated in cardiac rehabilitation (CR) program were categorized as the CR group, and others who did not participate as the control. Both groups underwent initial graded exercise test (GXT) and FMD testing. Subsequently, the CR group performed aerobic exercise training sessions. Patients in control only received advice regarding the exercise methods. After six weeks, both groups received follow-up GXT and FMD testing. RESULTS: There were 16 patients in each group. There were no significant differences in the general characteristics between the groups. The VO2peak was 28.6+/-4.7 mL/kg/min in the CR group and 31.5+/-7.4 mL/kg/min in the control at first GXT, and was 31.1+/-5.1 ml/kg/min in the CR group and 31.4+/-6.0 ml/kg/min in the control at the follow-up GXT in six weeks. There was a statistically significant improvement in VO2peak only for CR group patients. FMD value was 7.59%+/-1.26% in the CR group, 7.36%+/-1.48% in the control at first and 9.46%+/-1.82% in the CR group, and 8.31%+/-2.04% in the control after six weeks. There was a statistically significant improvement in FMD value in the CR group. CONCLUSION: According to the results of GXT and FMD testing, six-week exercise-based CR program improved VO2peak and endothelial functions significantly. Thus, exercise-based CR program is necessary in patients with coronary artery disease.
Acute Coronary Syndrome* ; Coronary Artery Disease ; Endothelial Cells ; Exercise Test ; Exercise* ; Follow-Up Studies ; Humans ; Percutaneous Coronary Intervention ; Rehabilitation ; Ultrasonography

PURPOSE: To describe the imaging findings at susceptibility weighted imaging (SWI) at 3T in patients with occlusion of middle cerebral artery, and to correlate the absence or presence of arterial bright foci in sylvian fissure, as one of their finding at SWI, with the diffusion weighted imaging (DWI) scores. MATERIALS AND METHODS: We included 12 patients with symptomatic unilateral occlusion of middle cerebral artery. Retrospective review of SWI and DWI was done. On DWI, size of infarction was analyzed according to the ASPECTS grading system. On SWI, presence of hemorrhage, dark blooming of intravascular clot, distension of medullary or cortical vein, and absence or presence of bright arterial foci in sylvian fissure were evaluated. RESULTS: Of 12 patients with symptomatic unilateral MCA occlusion, SWI showed dark blooming of intravascular clot in 8 patients (66.7%), distended medullary or cortical vein in 7 patients (58.3%), nonvisualization of arterial bright signal intensity in sylvian fissure in 7 patients (58.3%), and hemorrhage in one patient (8.3%). In comparison with DWI, patients with sylvian arterial bright signal intensity showed better ASPECTS score (6.4+/-4.1) than patients without arterial bright signal intensity (4.4+/-1.1), yet it was not statistically significant (p=0.267, t-test). CONCLUSION: SWI at 3T provides added diagnostic information including site of occlusion, collateral flow by arterial bright signal intensity in sylvian fissure and early hemorrhagic transformation in patients with symptomatic MCA occlusion.
Diffusion ; Hemorrhage ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Middle Cerebral Artery ; Retrospective Studies ; Stroke ; Veins

OBJECTIVE: To compare the low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) with high frequency (20 Hz) rTMS on motor functional improvement of the affected upper extremity in subacute stroke patients. METHODS: Forty patients with subacute ischemic stroke participated in this study. The first group received 10 sessions of 20 Hz rTMS at ipsilesional M1 area and the other group received 10 sessions of 1 Hz rTMS at contralesional M1 area. Motor training of the hemiparetic hand was conducted after each rTMS train. All the patients received conventional occupational therapy immediately after each rTMS session. Manual function test (MFT), Fugl-Meyer Assessment scale (FMS), Modified Barthel Index (MBI), Brunnstrom recovery stage, and grip strength were used to assess motor function before, at the end of, and one month after the last session of rTMS. RESULTS: No adverse side effects were reported during the course of the experiment using rTMS. No significant difference in motor function of the affected upper extremity was observed between the two groups before rTMS. Significant improvements in MFT, FMS, MBI, and Brunnstrom stage were observed in the both groups at the end of the last rTMS session and one month later (p<0.05). No significant difference was found between the two groups (p>0.05). CONCLUSION: There was no significant difference in motor function of the affected upper extremity between 1 Hz and 20 Hz rTMS during the subacute period of ischemic stroke. Thus, we cannot conclude which has a greater effect.
Hand ; Hand Strength ; Humans ; Occupational Therapy ; Stroke* ; Transcranial Magnetic Stimulation ; Upper Extremity

BACKGROUND AND OBJECTIVES: Occult multifocal diseases are often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). There has been considerable debate with regard to whether multifocal diseases actually behave more aggressively compared with unifocal diseases, particularly PTMC. The present study aimed at evaluating the clinical impact of occult multifocal diseases on the recurrence of PTMC treated with hemithyroidectomy. SUBJECTS AND METHOD: We compared the clinicopathological characteristics and 5-year outcomes for 319 patients with unifocal PTMC patients and 29 patients with occult multifocal PTMC, all of whom were treated with hemithyroidectomy between January 2004 and December 2010. RESULTS: The incidence of occult multifocal disease was 8.4%, with a mean size of 0.28 cm. Although microscopic extrathyroidal extension (ETE) was more frequent in patients with occult multifocal PTMC as compared with that of unifocal diseases (41.4% vs. 23.2%, p=0.030), multifocality was not associated with age, primary tumor size, and concurrent Hashimoto's thyroiditis. With respect to recurrence, there was no difference between the unifocal and multifocal groups during the mean 55.8-month follow-up period (4.4% vs. 10.3%, p=0.160). In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and presence of occult multifocal diseases in patients with PTMC treated with hemithyroidectomy. CONCLUSION: Although presence of occult multifocal diseases was associated with microscopic ETE, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, multifocality identified after hemithyroidectomy would not be an absolute indication for the completion of thyroidectomy in patients with PTMC.
Follow-Up Studies ; Humans ; Incidence ; Multivariate Analysis ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Thyroiditis

Since branchial anomalies are developmental disorders, pyriform sinus fistula (PSF) has been considered as a pediatric disease, and most reports of PSF with clinical symptoms have thus been on neonatal and young children. There are only a few case reports worldwide, of PSF found in adult patients. Here, we report a case where the patient's initial symptom of PSF occurred at the age of 72. Interestingly, papillary thyroid carcinoma (PTC) was concurrently identified on computed tomography during the evaluation for PSF. Chemical cauterization and total thyroidectomy was performed for the treatment of PSF and PTC, respectively. This case report may contribute to increased awareness of PSF in adult patients and the possible coexistence of thyroid cancer in these patients.
Adult ; Aged* ; Cautery ; Child ; Fistula* ; Humans ; Pyriform Sinus* ; Thyroid Neoplasms* ; Thyroidectomy