PURPOSE: Rupture of pre-existing cerebral aneurysms has been reported as a cause of traumatic subarachnoid hemorrhage (TSAH). SAH due to rupture of pre-existing cerebral aneurysm is an important differential diagnosis in TSAH. Our study was aimed to assess whether a rupture in a pre-existing cerebral aneurysm could be predicted on the basis of the quantity and distribution pattern of hemorrhage on the initial computed tomography (CT). METHODS: 197 patients with TSAH were retrospectively studied between the years 2003 and 2008. We examined the age and sex of patients, mechanisms of injury, consciousness level at admission, and CT parameters including the distribution and quantity of SAH, localized blood clot, intraventricular hemorrhage, or hemorrhagic contusion and extra-axial hematoma. We compared the patients with nonaneurysmal TSAH to the patients with aneurysmal TSAH. RESULTS: 22(11.2%) patients with TSAH harbored pre-existing cerebral saccular aneurysms. The aneurysms were found in the patients with diffuse or anteriorly located blood in the basal cisterns(40.6%), unilateral sylvian fissure (16.7%), and anterior interhemispheric fissure(18.2%). But the aneurysm was not found in all patients with perimesencephalic hemorrhage, bilateral sylvian fissures, and convexities. TSAH with localized clot in the anterior interhemispheric or sylvian fissure (OR=5.924, p=0.005), or SAH completely filling any cistern or fissure (OR=3.148, p=0.034) was significantly associated with rupture of pre-existing cerebral aneurysm in logistic regression analysis. CONCLUSION: SAH in the basal cisterns extended into bilateral sylvian fissures and anterior interhemispheric fissure, and SAH in the unilteral sylvian fissure on initial CT could be predicted rupture of pre-existing cerebral aneurysm.
Aneurysm ; Consciousness ; Contusions ; Craniocerebral Trauma ; Diagnosis, Differential ; Head ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Logistic Models ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic ; Tomography, X-Ray Computed

Subacute sensory neuropathies associated with primary Sjogren's syndrome have been reported rarely. We describe a woman with primary Sjogren's syndrome who developed a widespread, pure sensory neuropathy with a subacute onset. An electrophysiological study showed the typical absence or decreased amplitude of sensory nerve action potentials (SNAPs). A sural nerve biopsy showed a loss of large myelinated fibers and axonal degeneration without inflammation. The clinical course of long-standing subacute sensory neuropathy, the biopsy-documented axonal degeneration, and the neurophysiological findings suggest involvement of the dorsal root ganglia.
Action Potentials ; Axons ; Biopsy ; Female ; Ganglia, Spinal ; Humans ; Inflammation ; Myelin Sheath ; Peripheral Nervous System Diseases ; Sjogren's Syndrome* ; Sural Nerve

BACKGROUND: This study was performed to evaluate the effects of pretreatment with intralipos on the cardiovascular toxicity caused by continuous intravenous infusion with bupivacaine. METHODS: Fourteen healthy white rabbits were selected for this study and divided into the control group (n = 7) (normal saline administered for 30 minutes) and the intralipos pretreated group (n = 7) (intralipos administered for 30 minutes). The cardiovascular toxic effect during the continuous intravenous infusion of bupivacaine was observed between the control and the intralipos group by meaning the changes in mean arterial pressure, heart rate and electrocardiogram. RESULTS: In intralipos group, mean arterial pressure significantly increased after intralipos infusion for 30 minutes as compared with the control values (P < 0.05). The time intervals for 25, 50, 75 and 100% decrease in mean arterial pressure and heart rate and the onset time of the first QRS modification and dysrhythmia during continuous intravenous infusion of bupivacaine were significantly prolonged in the intralipos group compared with the control group (P < 0.05). The time intervals for 100% decrease in heart rate after the stop of bupivacaine administration was significantly prolonged in the intralipos group compared with the control group (P < 0.05). CONCLUSIONS: The present study suggests that prophylactic intravenous infusion with intralipos prevents the cardiovascular toxicity caused by bupivacaine in rabbits.
Arterial Pressure ; Bupivacaine* ; Electrocardiography ; Heart Rate ; Infusions, Intravenous ; Rabbits*

OBJECTIVES: This preliminary study evaluated the efficacy of two short-term programs for reducing depressive symptoms in female adolescents with depressive disorder. METHODS: The participants were 23 middle school students who were randomly assigned to three groups: the cognitivebehavioral program group, the psychoeducation-program group and the no-intervention control group. RESULTS: At postintervention, the students in cognitive-behavioral program group reported significantly lower levels of depressive symptoms, negative self-statement, automatic thought and psychiatric symptoms than did those in the nointervention group and those in the psychoeducation-program group. CONCLUSIONS: The results suggest that the cognitive-behavioral program for female adolescent with depressive disorder was more effective in reducing depressive symptoms than the psychoeducation-program.
Adolescent ; Depression ; Depressive Disorder ; Female ; Humans

OBJECTIVE: Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. METHODS: Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54 +/- 12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. RESULTS: Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r = 0.74, P < 0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal, echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. CONCLUSION: This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.
Adolescence ; Adult ; Aged ; Aorta, Thoracic/ultrasonography* ; Arteriosclerosis/ultrasonography ; Coronary Disease/ultrasonography* ; Echocardiography, Transesophageal ; Female ; Human ; Male ; Middle Age ; Prospective Studies ; Risk Factors

BACKGROUND/AIMS: The aims of this study were to determine subgoups of functional dyspesia and to evaluate the short-term effect of cisapride in patients with functional dyspepsia in Korea. METHODS: 1025 patients, with a mean age of 42.6 years, with symptoms of functional dyspepsia, were recruited consecutively and upper gastrointestinal symptoms were investigated by interview in 41 hospitals in Korea. In an open, multicenter trial, 1025 patients received Smg of cisapride three times a day (TID) for at least .2 weeks for the treatment of symptoms of functional dyspepsia. When necessary, the dose of cisapride was increased to 10mg TID and the duration of therapy was extended to 4 weeks. RESULTS: The most frequently reported symptoms of functional dyspepsia were epigastric discomfort or fullness (85%), bloating (70%), belching (53%), early satiety (52%) and epigastric pain (46%) retrospectively. Subgroups of functional dyspepsia were as follows; dysmotility-like 73.5%, ulcer-like 39.7%, reflux-like 13.0%, and unspecified dyspepsia 14.0%. However, 33.2% of subjects with functional dyspepsia could be classified into more than one subgroup. Upper gastrointestinal symptoms were decreased to average 50.3% (range; 42.2 to 59.2%) after 2 weeks of cisapride treatment and to 25% (19.2 to 29.9%) after 4 weeks. cisapride therapy resulted in good or excellent improvement in 59.0% of the patients after two weeks, in 75% of patients after 4 weeks. Adverse events were occurred in 52 patients (5.8% of all patients), most commonly, loose stools or diarrhea (3.5%), abdominal pain (1.1%), and dizziness (0.3%). The majority of adverse events was mild and transient in nature and led to premature discontinuation of treatment in 4 patients. CONCLUSIONS: Although the majorities of patients with functional dyspepsia have dysmotility like symptoms in Korea, there is such overlap among the dyspepsia subgroups. Most patients responded well to a short therapeutic trial with cisapride without significant side effects.
Abdominal Pain ; Cisapride* ; Diarrhea ; Dizziness ; Dyspepsia* ; Eructation ; Humans ; Korea* ; Retrospective Studies