This study investigated the differences in the effect of repetitive transcranial magnetic stimulation (rTMS) between patients with and without the involvement of Broca's area (IBA).The medical records of 20 stroke patients treated with rTMS for non-fluent aphasia were reviewed. Patients completed the Korean version of the Western Aphasia Battery (K-WAB) pre- and post-rTMS. Magnetic resonance T1-weighted images of the brain were analyzed using SPM12 software. Montreal Neurological Institute templates and Talairach coordinates were used to determine Broca's area involvement and segregate patients into 2 groups: IBA and non-IBA (NBA) groups. All statistical analyses were performed using the SPSS software.Twenty subjects were included in the study. The K-WAB scores revealed improvements in the total subjects and IBA and NBA groups. There were no statistical differences between the IBA and NBA groups in the ΔK-WAB scores of aphasia quotient, fluency, comprehension, repetition, and naming. The rTMS was positive for non-fluent aphasia patients, but there was no significant difference in effectiveness depending on the IBA. Further research with a larger number of patients is needed to identify the differences in the effect of rTMS on the IBA.

Background: Esmolol as a drug for induced hypotension can, not only avoid many drawbacks of nitroprusside, but reduce the amount of intraoperative bleeding and make better operative field. This study was performed to evalute cardiovascular changes during esmolol-induced controlled hypotension. Methods: Induced hypotension using esmolol was applied to 18 adult patients receiving spinal surgery under the diagnosis of spinal stenosis or scoliosis. After prehydraion of 2,000 ml of crystalloid solution, 0.5 mg/kg esmolol was used as loading dose once, twice or three times until mean blood pressure (MBP) fell below 70 mmHg, followed by continuous infusion (50~300 microg/kg/min) of esmolol. MBP and heart rate (HR) were measured before, 5, 10, 15, 30, 60 and 90 min after esmolol administration, and 5, 10 and 15 minutes after discontinuation of esmolol. In 8 patients, cardiac output (CO) and mixed venous oxygen tension and saturation were measured before, during and after esmolol use. Results: MBP was decreased from 91+/-12 mmHg to 67+/-7 mmHg after 15 min (P<0.05). HR(BPM) was decreased from 76+/-17 to about 60 after 15 min (P<0.05). CO was decreased about 30% during induced hypotension but recoverd to initial level 15 min after esmolol discontinuation. While oxygen transport was reduced significantly during induced hypotension (P<0.05), oxygen consumption was maintained all the time. Conclusion: With the use of esmolol, stable hypotension could be achieved. Although oxygen transport decreased possibly due to reduction of CO, but oxygen consumption was maintained.
Adult ; Blood Pressure ; Cardiac Output ; Diagnosis ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Hypotension, Controlled ; Nitroprusside ; Oxygen ; Oxygen Consumption ; Scoliosis ; Spinal Stenosis

A retroperitoneal angiosarcoma is rare. Especially, a cystic change in retroperitoneal angiosarcoma is extremely rare and it is difficult to distinguish an angisarcoma with a cystic change in the differential diagnosis with other retroperitoneal cystic masses. We report here a case of a cystic change in a retroperitoneal angiosarcoma of a 61-year-old woman who complained of abdominal pain. Imaging studies, including ultrasonography and computed tomography, detected a lobulating cystic mass with inner enhancing irregular septations and walls in the retroperitoneum. The tumor was surgically resected and was histopathologically diagnosed as an angiosarcoma.
Abdominal Pain ; Diagnosis, Differential ; Female ; Hemangiosarcoma ; Humans ; Middle Aged

OBJECTIVES: Single-pill combination therapy (amlodipine/atorvastatin) might be more effective than double-pill therapy (amlodipine+atorvastatin) in patients with diabetes and concomitant hypertension requiring statin therapy. We compared the cost-effectiveness of a single-pill with that of double-pill for control of low density lipoprotein cholesterol (LDL-C) levels, with the ultimate goal of cardiovascular disease prevention, in these patients using a cost-effectiveness analysis model that considered medication adherence. METHODS: Effectiveness was defined as the percentage (%) attainment of target LDL-C levels (<100 mg/dL) based on adherence for each therapy. Adherence was defined as compliance to medication (> or =80% proportion of days covered). A systematic review of the literature was conducted to determine the proportion of patients who were adherent and target goal attainment based on adherence level. The annual medication costs were based on the adherence levels for each regimen. The average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of the target LDL-C level. RESULTS: The ACER for the single-pill regimen was lower than for the double-pill regimen (4,123 vs. 6,062 Korean won per 1% achievement of target goal). Compared with the double-pill, the medication costs were approximately 32% lower with the single-pill. CONCLUSION: A single-pill for reductions in LDL-C is cost-effective compared with double-pill in hypertensive patients with type 2 diabetes.
Acer ; Amlodipine ; Cardiovascular Diseases ; Cholesterol, LDL ; Compliance ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Korea* ; Lipoproteins* ; Medication Adherence ; Atorvastatin Calcium

An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft.
Angiography ; Carotid Artery Injuries ; Carotid Artery, Internal ; Caves ; Emergencies ; Female ; Hemorrhage ; Humans ; Lacerations ; Stents ; Young Adult

BACKGROUND AND PURPOSE: Recent randomized clinical trials (RCTs) have demonstrated benefits of endovascular recanalization therapy (ERT) contrary to earlier trials. We aimed to estimate the benefits of ERT added to standard therapy in acute ischemic stroke. METHODS: From a literature search of RCTs testing ERT, we performed a meta-analysis to estimate an overall efficacy and safety of ERT for all trials, stent-retriever trials, and RCTs comparing ERT and intravenous tissue plasminogen activator (IV-TPA). RESULTS: We identified 15 relevant RCTs including 2,899 patients. For all trials, ERT was associated with increased good outcomes (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.34, 2.40; P<0.001) compared to the control. ERT also increased no or minimal disability outcomes, good neurological recovery, good activity of daily living, and recanalization. ERT did not significantly increase symptomatic intracranial hemorrhage (SICH) (OR 1.19; 95% CI 0.83, 1.69; P=0.345) or death (OR 0.87; 95% CI 0.71, 1.05; P=0.151). In contrast, ERT significantly reduced extreme disability or death (OR 0.77; 95% CI 0.61, 0.97; P=0.025). Restricting to five stent-retriever trials comparing ERT plus IV-TPA vs. IV-TPA alone, the benefit was even greater for good outcome (OR 2.39; 95% CI 1.88, 3.04; P<0.001) and extreme disability or death (OR 0.57; 95% CI 0.41, 0.78; P=0.001). Restricting to eight RCTs comparing ERT (plus IV-TPA in six trials) with IV-TPA alone showed similar efficacy and safety. CONCLUSIONS: This updated meta-analysis shows that ERT substantially improves clinical outcomes and reduces extreme disability or death without significantly increasing SICH compared to standard therapy.
Humans ; Intracranial Hemorrhages ; Stroke* ; Thrombectomy ; Tissue Plasminogen Activator

Developmental foregut cysts, whether bronchogenic, esophageal, gastroenteric or pericardial, are frequently encountered in the mediastinum, and are also occasionally found in the upper abdomen, where they can mimic adrenal, pancreatic, renal or gastric masses. We present the computed tomographic (CT) and histologic findings of an intramuscular bronchogenic cyst of the gastric body, mimicking a retroperitoneal cystic mass. CT scanning demonstrated the presence of a relatively hyperattenuating cystic mass without enhancement. Histologic examination revealed a bronchogenic cyst secreting mucoid materials.
Abdomen ; Bronchogenic Cyst* ; Mediastinum ; Tomography, X-Ray Computed

BACKGROUND: Almost no study has been carried out to explore the cognitive characteristics of the oldest old population in Korea, even though Korean society is becoming very 'old'. The purpose of this study is to the examine basic cognitive functions of Korean elders over 100 years of age. METHODS: Data collection was completed with 87 elders, 12 males and 75 females. Their mean age was 103.2 for males and 102.3 for females. The average year of education for this population was less than 1 year(0.5 year). We evaluated cognitive functions by K-MMSE and the severity of dementia by CDR (Clinical Dementia Rating). RESULTS: Most of them were able to speak fluently(81.6%) and had reasonable vision(67.8%), but 55.2 % of subjects had full comprehension ability. There was no significant difference in results between elders from Seoul and from other country area. We have divided the sample population into 5 groups according to CDR score; 0(7.4%), 0.5(33.3%), 1(25.9%), 2(14.8%), 3(18.5%), to compare with K-MMSE score. There were significant differences in K-MMSE scores between CDR groups. DISCUSSION: About 7% of elders over 100 years of age are still maintaining normal cognitive function. Considering the physical handicaps of the subjects, probable dementia group(30%) can also be regarded as to possess near normal cognitive function. This study is the first study on Korean centenarians and will provide essential data for future studies on the oldest old.
Aged, 80 and over ; Comprehension ; Data Collection ; Dementia ; Education ; Female ; Humans ; Korea ; Male ; Seoul

OBJECTIVE: The definition of empty sella syndrome is 'an anatomical entity in which the pituitary fossa is partially or completely filled with cerebrospinal fluid, while the pituitary gland is compressed against the posterior rim of the fossa'. Reports of this entities relating to the brain tumors not situated in the pituitary fossa, have rarely been reported. METHODS: In order to analyze the incidence and relationship of empty sella in patients having brain tumors, the authors reviewed preoperative magnetic resonance imaging (MRI) of 72 patients with brain tumor regardless of pathology except the pituitary tumors. The patients were operated in single institute by one surgeon. There were 25 males and 47 females and mean patient age was 53 years old (range from 5 years to 84 years). Tumor volume was ranged from 2 cc to 238 cc. RESULTS: The overall incidence of empty sella was positive in 57/72 cases (79.2%). Sorted by the pathology, empty sella was highest in meningioma (88.9%, p = 0.042). The empty sella was correlated with patient's increasing age (p = 0.003) and increasing tumor volume (p = 0.016). CONCLUSION: Careful review of brain MRI with periodic follow up is necessary for the detection of secondary empty sella in patients with brain tumors. In patients with confirmed empty sella, follow up is mandatory for the management of hypopituitarism, cerebrospinal fluid (CSF) rhinorrhea, visual disturbance and increased intracranial pressure.
Brain ; Brain Neoplasms ; Empty Sella Syndrome ; Female ; Follow-Up Studies ; Humans ; Hypopituitarism ; Incidence ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Meningioma ; Pituitary Gland ; Pituitary Neoplasms ; Tumor Burden

Focal nodular hyperplasia (FNH) is characterized by the presence a central scar with radiating fibrous septa. Our case had a capsular retraction, which was the result of an extension of the central scar to the surface. In addition, a hypointense scar on the T2-weighted image and a minimal enhancing central scar on the enhanced T1-weighted image, which was due to dense, sclerotic collagenous tissue, were observed. We report the first case of FNH with a capsular retraction.