OBJECTIVE: To assess what are the predictive factors that differentiate between medical and surgical group and, to determine the group that can be treated more efficiently with early surgical intervention than with conservative medical management. METHODS: Clinical and epidemiologic factors from the medical records of 85 selected patients who had either medical (n=52) or surgical (n=33) treatments for Tubo-ovarian abscess in Dongguk university hospital from February 1998 to May 2003 were evaluated retrospectively. RESULTS: Prognosis was predictable on the basis of response to the medical therapy and the extent of the disease at the time of the diagnosis. There was apparent association with the age, parity factors and CRP values where higher the variables, surgical intervention was needed. Same results were obtained with the large size of the abscess according to the sonography and the usage of the intrauterine devices (p<0.005). No statistical significance was noted, however, with leukocytosis, ESR, previous PID or D and C history, or high body temperatures (all ranging p>0.05). CONCLUSION: Medical therapy in the patients with high parity or old age is most likely to fail if the size of the abscess is more than 6 cm, increased CRP value or using IUD as a contraceptive. These prognostic factors should be considered in the early surgical interventions to prevent the subsequent complications from the delay of treatments and also to reduce the duration.
Abscess* ; Body Temperature ; Diagnosis ; Epidemiologic Factors ; Female ; Humans ; Intrauterine Devices ; Leukocytosis ; Medical Records ; Parity ; Prognosis ; Retrospective Studies

OBJECTIVE: To assess what are the predictive factors that differentiate between medical and surgical group and, to determine the group that can be treated more efficiently with early surgical intervention than with conservative medical management. METHODS: Clinical and epidemiologic factors from the medical records of 85 selected patients who had either medical (n=52) or surgical (n=33) treatments for Tubo-ovarian abscess in Dongguk university hospital from February 1998 to May 2003 were evaluated retrospectively. RESULTS: Prognosis was predictable on the basis of response to the medical therapy and the extent of the disease at the time of the diagnosis. There was apparent association with the age, parity factors and CRP values where higher the variables, surgical intervention was needed. Same results were obtained with the large size of the abscess according to the sonography and the usage of the intrauterine devices (p<0.005). No statistical significance was noted, however, with leukocytosis, ESR, previous PID or D and C history, or high body temperatures (all ranging p>0.05). CONCLUSION: Medical therapy in the patients with high parity or old age is most likely to fail if the size of the abscess is more than 6 cm, increased CRP value or using IUD as a contraceptive. These prognostic factors should be considered in the early surgical interventions to prevent the subsequent complications from the delay of treatments and also to reduce the duration.
Abscess* ; Body Temperature ; Diagnosis ; Epidemiologic Factors ; Female ; Humans ; Intrauterine Devices ; Leukocytosis ; Medical Records ; Parity ; Prognosis ; Retrospective Studies

Behavioral and psychological symptoms of dementia are major components of Alzheimer’s disease. In this study, we aimed at investigating the prevalence and severity of behavioral and psychological symptoms of dementia in very mild to mild Alzheimer’s disease. Forty-four patients with Alzheimer’s disease who visited the neurology outpatient clinic of Seoul Medical Center were included. A trained neurologist or a supervised test technician administered the neuropsychological test, the Seoul Neuropsychological Screening Battery including Mini Mental State Examination and Clinical Dementia Rating. The instrument used for assessing behavioral and psychological symptoms of dementia was Neuropsychiatric Inventory-Questionnaire. In order of prevalence, apathy, depression, irritability, anxiety, and agitation were the most common symptoms occurring in very mild-to-mild Alzheimer’s disease group. The prevalence and severity of behavioral and psychological symptoms of dementia were found to be in positive correlation with the Clinical Dementia Rating scores. Behavioral and psychological symptoms of dementia are found even in the very early stage of Alzheimer’s disease, apathy and depression being the most common symptoms. Physicians should be aware of this when managing dementia patients.

PURPOSE: To evaluate the usefulness of magnetic resonance imaging (MRI) for assessing fracture types and soft tissue injuries associated with tibial plateau fractures. MATERIALS AND METHODS: MRI was performed in 38 patients with tibial plateau fractures, each of which was classified according to the Schatzker system. We evaluated MR images and assessed the prevalence of each fracture type and accompanying soft tissue injuries. We also assessed whether ligamentous injury correlated with the extent of articular depression, splitting, and comminution. In 24 patients, diagnosis was based on MRI and operative or arthroscopic findings, and in 14 patients, on MRI alone. RESULTS: The totals of fracture types I, II, III, IV, V and VI were 4 (11 %), 15 (39 %), 6 (16 %), 4 (11 %), 4 (11%), and 5 cases (13 %), respectively. In 30 cases (79 %), there were associated ligamentous or meniscal injuries. Medial collateral ligaments and lateral menisci were injured in 17 (45 %) and 14 cases (37 %), respectively. Type II and IV fracture patterns were associated with soft tissue injuries in 14 of 15 cases (93 %) and 4 of 4 cases(100 %), respectively. As the extent of articular depression increased and the extent of bony comminution decreased, there was an increased prevalence of accompanying ligamentous injuries. CONCLUSION: In tibial plateau fractures, MR imaging is a useful diagnostic modality for the evaluation of both fracture type and accompanying ligamentous or meniscal injuries.
Collateral Ligaments ; Depression ; Diagnosis ; Humans ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prevalence ; Soft Tissue Injuries*

Bilateral calcifications of the basal ganglia, the thalami, the dentate nuclei of the cerebellum, and the white matter of the cerebral hemisphere characterize Fahr's disease. The common clinical manifestations of the disease are movement disorders accompanied by cognitive impairment and mood disorder. Herein we report a case of Fahr's disease with atypical clinical manifestations. The patient was a 48 year-old man who presented with behavioral changes. His neurological examination showed no focal neurological deficits except for frontal dysfunctions. Abnormal involuntary movement was absent. Neuroimaging work-ups were compatible with Fahr's disease.
Basal Ganglia ; Cerebellum ; Cerebrum ; Dyskinesias ; Frontal Lobe* ; Humans ; Middle Aged ; Mood Disorders ; Movement Disorders ; Neuroimaging ; Neurologic Examination

PURPOSE: This study was conducted to analyze the change in the obesity index in girls receiving a gonadotropin-releasing hormone agonist (GnRHa), based on treatment duration, and to aid in nutritional counseling by investigating dietary habits and lifestyle. METHODS: Anthropometric examinations were conducted on 62 girls treated with GnRHa from January 2010 through July 2014. Parents were asked to fill out questionnaires on patient dietary habits and lifestyle. RESULTS: The group taking GnRHa for over 1 year had a higher rate of obesity increase than the group taking GnRHa for less than 1 year, but they had common habits related to obesity, which should be corrected. In addition, 69.2% of the normal weight group taking GnRHa for over 1 year gained weight, and needed more intensive programs, which include physical exercise and nutritional education. Although girls with precocious puberty showed a decrease in the intake of high-calorie foods with nutritional intervention regardless of treatment duration, they still had problems that needed improvement, such as shorter meals and lack of exercise. CONCLUSION: Girls with precocious puberty and their parents should emphasize maintenance of proper body weight, especially when treatment for over 1 year is anticipated. Consistent education in nutrition, ways to increase intensity and duration of physical activity, and the need to slow down mealtimes are important in managing obesity; doctors need to perform regular checkups and provide nutritional counseling.
Body Weight ; Counseling ; Education ; Exercise ; Female* ; Food Habits* ; Gonadotropin-Releasing Hormone ; Humans ; Life Style* ; Meals ; Motor Activity ; Obesity ; Parents ; Puberty, Precocious*

Lumbar puncture is a simple bedside procedure that is essential for the diagnosis and treatment of several neurologic diseases. Known complications include headache, backache, infection, and hemorrhage, with the most common being postpuncture headache. We report a case of postpuncture spinal subdural hematoma-which is extremely rare-in a 29-year-old female. Although most cases of postpuncture spinal hematomas are associated with coagulation abnormalities, this case shows that it can occur in the absence of predisposing factors.
Back Pain ; Female ; Headache ; Hematoma ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Spinal Puncture

PURPOSE: We attempted to evaluate the usefulness of Doppler sonography in the diagnosis of uterine vascular abnormality caused by previous D&E, and to report that transarterial embolization is an exceelent treatment modality. MATERIALS & METHODS: We analyzed gray-scale US, color/duplex Doppler US and angiographic findings inseven patients with radiologically proven uterine vascular abnormality. Two of the seven cases were pseudoaneurysms and five of the seven cases were AVMs. In one of the AVMs, two small pseudoaneurysms were combined. In all cases, transarterial embolizations using 3mm coil or/and gelfoam particles were performed. Follow-up US studies, including color Doppler US, were performed. RESULTS: On color/duplex Doppler sonography, two cases of pseudoaneurysm showed blood pools with turbulent arterial flow, and five cases of AVM showed asymmetrically increased vascularity, with variable high velocities composed of the pulsatie arterial flow, with ahigh diastoic component. On angiography, the former showed pseudoaneurysmal sacs, and the latter densely opacified vascular tangles. No more abnormal uterine bleeding was shown, following transarterial embolization in all cases. CONCLUSION: Color/duplex Doppler sonography was valuable in the diagnosis or treatment of abnormal uterine bleeding caused by uterine vascular abnormality such as acquired AVM or pseudoaneurysm.
Aneurysm, False ; Angiography ; Diagnosis* ; Gelatin Sponge, Absorbable ; Humans ; Uterine Artery ; Uterine Hemorrhage*

There are few reports about the systemic toxicity of mepivacaine, which is widely used for regional nerve blocks, because of its short onset time and intermediate duration, during or after blockades. We report two cases. In the first, a 70 year-old female with chronic renal failure and hypertension was scheduled for arteriovenous fistula formation under axillary brachial plexus block using 30 ml of 1.5% mepivacaine. In the second, a 69 year-old female with hypertension who was scheduled for total knee replacement under femoral/sciatic nerve block with lateral femoral cutaneous nerve block using 45 ml of 1.5% mepivacaine. Both had an exaggerated hemodynamic response (of increased blood pressure and heart rate) with symptoms and signs of central nervous system excitation not evolving to convulsions, which was induced by mepivacaine during or soon after the blockades. Possible causes and mechanisms of the events are discussed based on the literature.
Arteriovenous Fistula ; Arthroplasty, Replacement, Knee ; Blood Pressure ; Brachial Plexus ; Central Nervous System ; Female ; Femoral Nerve ; Heart ; Hemodynamics ; Humans ; Hypertension ; Kidney Failure, Chronic ; Mepivacaine ; Nerve Block ; Sciatic Nerve ; Seizures