OBJECTIVE: To evaluate the effect of methylphenidate on cognitive function especially on working memory and visuospatial attention in the patients with traumatic brain injury (TBI). METHOD: Eighteen subjects, 16 males and 2 females, with TBI were enrolled. Their mean age was 34.2 years old. A double-blind placebo-controlled study was designed. The baseline cognitive assessment was performed before the administration of drug. Two days after the baseline study, 20 mg of methylphenidate or placebo was administered. The second cognitive assessment was performed 2 hours after the treatment. The follow-up assessment conducted two days after the second test. Cognitive assessments consisted of 'one-back working memory task' and 'endogenous visuospatial attention task', designed using SuperLab Pro 2.0 software. RESULTS: In one-back working memory test, there was significant improvement of response accuracy in methylphenidate group in comparison with placebo group (p<0.01). Significant shortening of reaction time was also seen after the administration of drug in methylphenidate group (p<0.05). In endogenous visuospatial attention test, significant improvement of response accuracy was noticed after the administration of drug in methylphenidate group (p<0.05). CONCLUSION: These results demonstrated that the administration of methylphenidate was beneficial in improving cognitive function following TBI. The effect was prominent in the accuracy of working memory.
Brain Injuries* ; Brain* ; Female ; Follow-Up Studies ; Humans ; Male ; Memory, Short-Term ; Methylphenidate* ; Reaction Time

Ionizing radiation including I131 might produce chromosomal translocation, causing hematologic malignancy. The incidence of leukemia following radioactive iodine treatment for thyroid cancer has been reported to be approximately 0.1 to 2.0% in Western countries, whereas fewer cases have been reported in Korea. We hereby report four cases of secondary hematologic malignancy, who received iodine therapy for thyroid cancer after thyroidectomy: two cases of acute lymphoblastic leukemia with t(9;22)(q34;q11.2), a case of MDS with 5q deletion, and a case of MDS with normal karyotype. Three cases of hematologic malignancy have developed after cumulative dosage of less than 800 mCi. The treatment intervals in two cases were less than 12 months, and the other two cases had I131 therapy only once. Assessment of causality using the Naranjo probability scale for adverse drug reactions showed that a 'possible' relationship existed between the use of I131 and secondary hematologic malignancy in all of the four cases in this report.
Adult ; Chromosomes, Human, Pair 22 ; Chromosomes, Human, Pair 5 ; Chromosomes, Human, Pair 9 ; Female ; Gene Deletion ; Hematologic Neoplasms/*diagnosis/genetics ; Humans ; Iodine Radioisotopes/*adverse effects/therapeutic use ; Leukemia, Radiation-Induced/*diagnosis/etiology ; Middle Aged ; Myelodysplastic Syndromes/diagnosis/genetics ; Neoplasms, Second Primary/*diagnosis/genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/genetics ; Thyroid Neoplasms/*radiotherapy ; Thyroidectomy ; Translocation, Genetic

PURPOSE: The purpose of this study was to assess the clinician satisfaction of a newly introduced around-the-clock radiology coverage system for the emergency department. MATERIALS AND METHODS: Seventeen emergency physicians (8 board certified physicians, 9 residents) were invited to fill out a survey pertaining to the newly introduced radiology coverage system for the emergency department. The questionnaire included 10 questions covering three major topics. The first topic related to the around-the-clock radiology coverage by two full-time radiology residents. The second topic focused on the preliminary interpretations of radiology residents. The last topic included the interpretation assistance system by board-certified radiologists. The answers to each question were assessed using a scoring system of 1 to 5. RESULTS: The mean satisfaction score of the around-the-clock radiology coverage system by the two full-time radiology residents was 4.6 (range 3-5). The mean score for the preliminary interpretation system by the radiology residents was 4.8 (range 4-5). The score for the reliability of the preliminary versus the final interpretations was 4.1 (range 4-5). Lastly, the mean score for the interpretation assistance system by board-certified radiologists was 4.9 (range 4-5). CONCLUSION: The results of this study indicate a high satisfaction rating among clinicians' of the new around-the-clock radiology coverage system for the emergency department.
Emergencies ; Emergency Service, Hospital ; Surveys and Questionnaires

Free-floating tumor debris or mucobilia as a cauae of intermittent obstruction has been described infrequently. A middle aged woman with intermittent jaundice caused by abundant mucus from an intrahepatic mucinous cholangiocarcinoma is presented. Symptoms of juandice, midepigastric pain and fever developed despited an intitial cholecystectomy and common bile duct stone extraction using endoscopic retrograde cholangography (ERCP). Intraductal mucin was diagnosed through on ERCP and confirmed intraoperatively and pathologically as the cause of the obstructive juandice. The patient remained asymptomatic and without evidence of disease for more than 2 years postoperatively. Description is presented of the patient who was admitted presented with recurrent cholangitis caused by profuse secretion of mucus by mucin-producing cholangiocaricnoma, with a review of relevant literature.
Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Cholecystectomy ; Common Bile Duct ; Female ; Fever ; Humans ; Jaundice ; Middle Aged ; Mucins* ; Mucus

Keratoacanthoma is a rapidly growing tumor that histologically resembles squamous cell carcinoma. Surgical excision is a desirable therapeutic option, but several other treatment modalities are available. We report on two cases of keratoacanthoma that were treated with imiquimod 5% cream. Imiquimod was applied daily for the first 6 or 7 days, and then reduced to alternate days according to the tolerance and erythema severity of the patient. In both patients, the tumors fully regressed after five weeks of treatment.
Carcinoma, Squamous Cell ; Erythema ; Humans ; Keratoacanthoma*

BACKGROUND/AIMS: The incidence of Helicobacter pylori (H. pylori)-positive ulcer appears to be decreasing recently in the Western countries, and this has been influenced by the epidemiologic changes of H. pylori infection. Therefore, we aimed to determine the trends for the frequency of H. pylori-positive peptic ulcer disease (PUD) during recent 7 years in Korea. METHODS: All 1,723 patients who had an endoscopic diagnosis of PUD from 1997 to 2003 were included in this study. H. pylori was considered present if the CLO test and/or the histology and the urea breath test were positive for H. pylori. RESULTS: H. pylori-positive ulcers were seen in 1,354/1,723 patients (78.6%). The positive rate of H. pylori infection in patients with PUD was 85.9% in 1997, 79.2% in 1999, 76.2% in 2001 and 73.1% in 2003, and this showed a decreasing annual trend (p<0.001). H. pylori-positive PUD was more prevalent in duodenal ulcer than in gastric ulcer, and in the patients who were aged person and male. During the recent 7 years, H. pylori- positive PUD has decreased in patients with duodenal ulcer, and especially for patients younger than 60 years and in the male group. CONCLUSIONS: The frequency of H. pylori-positive PUD is possibly decreasing in the recent 7 years. Prospective, multicenter trial studies are necessary to confirm this trend and find out the cause.
Breath Tests ; Diagnosis ; Duodenal Ulcer ; Helicobacter pylori ; Helicobacter* ; Hospitals, General* ; Humans ; Incidence ; Korea ; Male ; Peptic Ulcer* ; Stomach Ulcer ; Ulcer ; Urea

Little literature exists about the risk of atypical femoral fracture in patients received zoledronic acid for prevention of skeletal metastasis. We report an atypical subtrochanteric femoral fracture in a patient with multiple myeloma received zoledronic acid. The patient was treated by closed reduction and internal fixation with cephalomedullary nailing.
Diphosphonates ; Femoral Fractures ; Humans ; Imidazoles ; Multiple Myeloma ; Nails ; Neoplasm Metastasis

Basal cell carcinoma (BCC) is the most common skin cancer of humans. The incidence of BCC is closely correlated with sun exposure, as well as older age. Because of this, BCCs are frequently found on sun-exposed areas of fair-skinned, older individuals. The axilla is one of the sun-protected sites where BCC rarely develops. We herein report three unusual cases of primary BCC which arose from the axilla.
Axilla* ; Carcinoma, Basal Cell* ; Humans ; Incidence ; Skin Neoplasms ; Solar System

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.
Aorta, Thoracic ; Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia ; Axis, Cervical Vertebra ; Diagnosis* ; Diaphragm ; Humans ; Magnetic Resonance Imaging*

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.
Aorta, Thoracic ; Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia ; Axis, Cervical Vertebra ; Diagnosis* ; Diaphragm ; Humans ; Magnetic Resonance Imaging*