No abstract available.
Tibia*

OBJECTIVES: REM sleep behavior disorder (RBD) has received little attention in epidemiologic studies. This study aimed to determine the prevalence of probable REM sleep behavior disorder (pRBD) in the elderly population and its clinical features. METHODS: A random sample of 1,588 was selected from a roster of 14,050 elderly population living in Osan city. The subjects were asked to fill out the REM sleep behavior disorder screening questionnaire (RBDSQ). Subjects whose score were 5 or higher on RBDSQ underwent a diagnostic phase of person-to-person assessment by experts in RBD. RESULTS: Among 1,588 subjects, 886 elderly subjects participated in the screening phase and 123 subjects were assessed in the diagnostic phase. Eleven subjects were diagnosed as having pRBD, so prevalence was 1.5% (95% CI=0.70-2.30%). The frequency of depression and cognitive decline was significantly increased in patients with pRBD compared to subjects without pRBD, and there was no difference in sleep disturbances between two groups. CONCLUSIONS: Probable REM sleep behavior disorder is not rare in the elderly but frequently under-recognized. More attention should be paid to evaluation and treatment of RBD.
Aged ; Depression ; Epidemiologic Studies ; Humans ; Mass Screening ; Prevalence ; Surveys and Questionnaires ; REM Sleep Behavior Disorder ; Sleep, REM

Pain from cancer is a major problem of managing the oral cancer patients in terminal stage. Overall, pain is reported by about 50% of patients at all stages of cancer and by over 70% with advanced neoplasms. Unrelieved pain can be incapaciting and preclude a satisfying quality of life. But, pain is often poorly assessed, and many clinicians lack sufficient knowledge to optimize cancer pain treatment. There are three basic approaches to the control of pain : modifying the source of pain, altering the central perception of pain, and blocking the transmission of pain to the central nervous system. The optimal use of these approaches and an individualized plan for pain control can maximize both quality and duration of life in dying patients. Opioid analgesics are are the mainstay of pharmacologic treatment. Practical opioid therapy include selection of both drug and route, dose titration, and management of side effects. We present our experienced pharmacologic treatment protocol for cancer pain management that collaborated by Dept. of Hospice, Catholic Medical Center. It will acts as a guideline for our colleague to facilitate the translation of current knowlegde into the clinical practice.
Analgesics, Opioid ; Central Nervous System ; Clinical Protocols ; Hospices ; Humans ; Mouth Neoplasms* ; Pain Management ; Quality of Life

OBJECTIVES: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. METHODS: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. RESULTS: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. CONCLUSIONS: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.
Aged* ; Dementia* ; Education ; Female ; Gangwon-do ; Humans ; Pain Measurement ; Pain Threshold*

We studied the intradural variations of spinal nerve rootlets in 100 cases of Korean adults. The results of the study are as follows ; 1. The incidence of intrasegmental variations (abberrant rootlets) is high in cervical segments and decreased toward lumbosacral segments. The incidence is higher in posterior rootlets than anterior, except cervical sesments. 2. The incidence of intersegmental variations is higher in posterior rootlets than anterior, and generally high in cervical and lumbar segments. 3. We divide the intersegmental variations into supernumerary rootlets, dividing rootlets, and anastomosing rootlets, and among them the incidence of anastomosing rootlets is higher. We divide the anastomosing rootlets into parallel anastomosing rootlets, uniting anastomosing rootlets, and rearrangement anastomosing rootlets. 4. The anterior to posterior anastomosing of spinal nerve rootlet is present in 4 of cases studied.
Adult ; Humans ; Incidence ; Spinal Nerves*

No abstract available.
Brain* ; Hydrocephalus*

Several cases of pulmonary air embolisms during surgery have been reported. However, such incidences are very rare during endoscopic surgeries. A 5-year-old boy with third ventricular arachnoid cyst and hydrocephalus underwent endoscopic third ventriculostomy under the general anesthesia, during which continuous intraventricular irrigation was maintained with normal saline. During the procedure, arterial and transcutaneous oxygen tension and end-tidal carbon dioxide tension became suddenly decreased while arterial carbon dioxide tension increased. Within 3 minutes after the inspired gas mixture was changed to 100% oxygen, the patient's respiratory variables returned to near base line. The second attack occured about 10 minutes later and decreased arterial oxygen tension with increased arterial carbon dioxide tension continued for about 5 minutes. After waking up from anesthesia, the patient suffered a generalized seizure attacks that was managed with anticonvusant therapy. We believe that we are the first to report an attack of pulmonary air emblism during brain endoscopic procedure. It was reported with the review of literatures.
Anesthesia ; Anesthesia, General ; Arachnoid ; Brain ; Carbon Dioxide ; Child, Preschool ; Embolism, Air* ; Humans ; Hydrocephalus ; Incidence ; Male ; Oxygen ; Pulmonary Embolism ; Seizures ; Ventriculostomy*

BACKGROUND AND OBJECTIVES: The eosinophil plays an important role in allergic inflammation and the eosinophil cationic proteins (ECP) is one of the major granular proteins during its activation. ECP is proved to have an eosinophil specificity and reflects the activity of the eosinophil in the target site. We tried to identify the difference in the ECP levels between the nasal secretion of allergic and nonallergic rhinitis. MATERIALS AND METHODS: In order to draw a correlation between the ECP level and other diagnostic methods of allergy, we examined ECP in serum and nasal secretion of 20 patients with mite allergy and 20 non-allergic rhinitis patients. We also performed symptom questionnaires, acoustic rhinometry, the Wright-Giemsa staining of nasal brushings, and total amount of IgE in nasal secretion. RESULTS: ECP level in the nasal secretion of allergic patients after allergen challenge was higher than that of non-allergic rhinitis patients (p=0.026). We also found that the ECP level of allergic patients was higher after allergen provocation than before (p=0.005). Additionally, there was a negative correlation between the minimal cross-sectional area in acoustic rhinometry and the ECP level in the nasal secretion before the challenge (r=- 0.54, p=0.01). CONCLUSION: We concluded that ECP is the soluble marker which reflects the severity of allergic inflammation in the nose and is useful for diagnosis as well as in the follow-up care of nasal allergic inflammation.
Diagnosis ; Eosinophil Cationic Protein* ; Eosinophils* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inflammation ; Mites ; Nose ; Surveys and Questionnaires ; Rhinitis* ; Rhinometry, Acoustic ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: To investigate the effectiveness of fine needle aspiration (FNA) conducted by the otolaryngologists, we compared the ultrasound (US)-guided FNA results conducted by a radiologist (RD-US), the US-guided FNA results (ENT-US), and the palpation guided FNA results (ENT-palpation) conducted by an otolaryngologist. SUBJECTS AND METHOD: 1646 patients who underwent FNA were classified according to the site and periods of investigation (2007-2015), and their sampling adequacy was retrospectively reviewed. They were also divided into three groups (ENT-US, ENT-palpation, and RD-US); each group was then investigated for sampling adequacy. Results of further surgical excisional biopsy were compared with the those of the FNA results to investigate the diagnostic accuracy of all three groups. RESULTS: The sampling adequacy identified by the groups showed the result of ENT-US at 87.9%, ENT-palpation at 87.1% and RD-US at 91.3%. The periodical inadequacy rate failed to show any significant differences between the groups. The sensitivity of ENT-palpation was lower than other two groups. Diagnostic accuracy identified by the groups showed the result of ENT-US at 95.2%, ENT-palpation at 93.6%, and RD-US at 97.4%. CONCLUSION: FNA performed by otolaryngologists demonstrates the effectiveness of diagnosis and treatment, and that doing so would improve economic efficiency. Therefore, it is recommended that well-trained otolaryngologists conduct FNA actively.
Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Humans ; Methods ; Palpation ; Retrospective Studies ; Ultrasonography

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify clinical features and risk factors helpful for the prevention and early diagnosis of neurological complications. OVERVIEW OF LITERATURE: Previous studies have investigated postoperative complications only for specific disease entities and did not present distinctive clinical features. MATERIALS AND METHODS: This was an observational study of patients who underwent posterior thoracolumbar spinal surgery in the orthopedic department of a single hospital over the course of 19 years (1995-2013). The incidence, cause, onset time, and risk factors of complications were investigated. Neurological deterioration was graded on a 5-point numeric scale: G1, increased leg pain or sensory loss, G2, unilateral motor weakness; G3, bilateral motor weakness; G4, cauda equina syndrome; and G5, complete paraplegia. RESULTS: Sixty-five cases out of 6574 (0.989%) developed neurological complications due to the following causes: epidural hematoma, 0.380%; instrumentation with inadequate decompression, 0.213%; mechanical injury, 0.167%; inadequate discectomy, 0.061%; and unknown cause, 0.167% (p=0.000). The grade of neurological deterioration was G1 in 0.167% of patients, G2 in 0.517%, G3 in 0.228%, G4 in 0.046%, and G5 in 0.030%. Neurological deterioration was most severe in patients who experienced epidural hematoma, followed by those in whom complications occurred due to instrumentation with inadequate decompression, unknown causes, mechanical injury, and inadequate discectomy, in order (p=0.009). Revision surgery was a significant risk factor (p=0.000; odds ratio, 2.741). The time that elapsed until symptom development was as follows, in order: unknown cause, 0.6 hours; epidural hematoma, 5.4 hours; mechanical injury, 6.6 hours; inadequate discectomy, 18.0 hours; and instrumentation with insufficient decompression, 36.0 hours (p=0.001). CONCLUSIONS: The incidence of neurological complications in our cohort was 1%. Revision surgery increased the risk by 3 times. Severe cases (cauda equina syndrome or complete paraplegia) rarely developed, occurring in 0.08% of patients. The major causes of neurological decline were epidural hematoma and instrumentation with inadequate decompression. Close observation in the early period was important for the diagnosis because most patients developed symptoms within 12 hours. Delayed diagnosis was most common in complications caused by instrumentation with inadequate decompression.
Cohort Studies ; Decompression ; Delayed Diagnosis ; Diagnosis ; Diskectomy ; Early Diagnosis ; Hematoma ; Humans ; Incidence ; Leg ; Observational Study ; Odds Ratio ; Orthopedics ; Paraplegia ; Polyradiculopathy ; Postoperative Complications ; Retrospective Studies ; Risk Factors