Background & Significance : Hallervorden-Spatz disease (HSD) is a rare neurologic disorder characterized by progressive dystonia, retinal degeneration, pyramidal sign, and mental deterioration. The neuropathological findings include preferential deposition of iron within the extrapyramidal nuclei, including globus pallidus, substantia nigra, and red nuclei. The final diagnosis depends on the typical pathologic findings. MRI brain imaging study commonly shows so-called "eye-of-the-tiger" in the globus pallidus. However 1H-MRS findings of HSD have not been reported. We experienced a case with clinically suspicious HSD whose diagnosis was further supported by 1H-MRS. Case : A forty four year-old man presented with slowly progressive dystonia for six years. He had been well until age of thirty eight, when he noticed clumsy hand-writing. Three years later, he developed difficulty in chewing. Clumsiness of his hands and arm movements progressed to the point of difficulty in using spoon and chopsticks. While walking, arm swing was decreased and both arms and neck took more dystonic posture. Brain MRI (T2Wl) showed symmetric high signal intensity lesions in the globus pallidus, surrounded by a peripheral zone of exaggerated low signal. On 1H-MRS of basal ganglia, although choline, creatine and N-acetyl-aspartate (NAA) peaks were detected, marked noise probably due to paramagnetic substance (iron), made quantitative analysis difficult. Conclusion : 1H-MRS of HSD is characterized by "noise", which may be suggestive of HSD.
Adult* ; Arm ; Basal Ganglia ; Brain ; Choline ; Creatine ; Diagnosis ; Dystonia ; Globus Pallidus ; Hand ; Humans ; Iron ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy* ; Mastication ; Neck ; Nervous System Diseases ; Neuroimaging ; Noise ; Pantothenate Kinase-Associated Neurodegeneration* ; Posture ; Protons* ; Retinal Degeneration ; Substantia Nigra ; Walking

Objective: : Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods: : Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results: : Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0–2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, nonrecanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/ D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion : The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.

PURPOSE: The purpose of this study is to assess healthrelated quality of life (HRQOL) in patients with injury in the Emergency department, to compare that HRQOLs with normal control group, and to offer the results of this study as basic data on the HRQOL in Korean patients with injury, in the Emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 266 eligible injury patients who had visited our emergency center were enrolled in the study. The HRQOL was measured by using the Korean Short Form Health Survey-36 (KSF-36)and the Korean EuroQol 5 dimensions (KEQ-5D). The HRQOL was assessed at 10 days after injury. The severity of injury was measured by using the Injury Severity Score (ISS). RESULTS: Of the 266 subjects, 164 (61.7%) were men and 102 (38.3%) were women, with a mean (+/-SD) age of 42.8 (+/-15.2) and mean ISS (+/-SD) of 4.54 (+/-3.98). The KSF- 36 and KEQ-5D scores in patients with injury were significantly lower than those in the normal control group. The HRQOL scores of each group by cause of injury had significant differences in the KSF-36 MCS and the KEQ-5D utility index, but they had no significant differences in the KSF-36 PCS. Women were more likely to have poor HRQOLs than men, but no statistical significance was found. Patients with non-intentional injury and hospitalized were more likely to have poor HRQOLs than patients with intentional injury and discharged, but the statistical significance varied with the measurement tool. CONCLUSION: In this study, we observed that the HRLOQs in patients with injury were lower than those in healthy subjects. However, if more definite feature of HRLOQ in patients with injury are to be defined, a study with a large epidemiologic controlled injury group and with detailed adjustments of the variable is needed.
Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Injury Severity Score ; Male ; Quality of Life* ; Wounds and Injuries

PURPOSE: The purpose of this study is to show the correlation between Health-related quality of life (HRQOL) score and injury severity score (ISS) in patients with injury in emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 234 eligible injury patients who had visited our emergency center were enrolled in the study. HRQOL was assessed in 10 days after injury by Korean Short Form Health Survey- 36(KSF-36), Korean EuroQol 5 dimensions (KEQ-5D), and Korean Human Utility Index-3(KHUI-3). The severity of injury was measured by using the ISS. RESULTS: Of the 234 subjects, 149(63.7%) were men and 85(36.3%) were women, with mean(+/-SD) age of 46.1(+/-15.3) and mean ISS(+/-SD) of 4.54(+/-3.98). The KEQ-5D and KHUI-3 scores adjusted by ISS in patients with medical operation or hospitalization were significantly lower than those in patients without medical operation or hospitalization. All HRQOL scores except KSF-36 physical component summary (PCS) and general health (GH) score were significantly lower in patients group with high ISS than in patients group with low ISS. KEQ-5D and KHUI-3 had significant negative correlation with ISS (r=-0.58,-0.52). But there were no significant correlation between KSF-36 score and ISS. CONCLUSION: In this study, we observed that KEQ-5D and KHUI-3 scores in patients with injury were significantly correlated with ISS. However, to define the more definite feature of HRQOL in patients with injury, the study with more and large epidemiologic controlled injury group and detailed variable adjustment should be done.
Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitalization ; Humans ; Injury Severity Score* ; Male ; Quality of Life* ; Wounds and Injuries

Objective: The aim of the present study was to explore whether or not cancer patients’ viral anxiety and depression during the coronavirus-2019 (COVID-19) pandemic were associated with a fear of cancer progression. We also assessed whether coping strategies affected the relationship. Methods: The present cross-sectional survey included cancer patients who visited Ulsan University Hospital in Ulsan, Korea. The participants’ demographic information and responses to the following symptoms rating scales were collected: Stress and Anxiety to Viral Epidemic–6; Patient Health Questionnaire–9; Cognitive Emotion Regulation Questionnaire-short version; or Fear of Progression Questionnaire-short version. Results: Of the 558 cancer patients surveyed, 25 (4.5%) reported that their treatment schedule was delayed during the COVID-19 pandemic. The patients’ fear of progression was found to be related to age (β=-0.08; p=0.011), viral anxiety (β=0.40; p<0.001), depression (β=0.26; p<0.001), and catastrophizing coping strategies (β=0.15; p=0.004), for an overall adjusted R2 of 0.46 (F=66.8; p<0.001). Mediation analysis showed that viral anxiety and depression were directly associated with fear of progression, while catastrophizing mediated this relationship. Conclusion Fear of progression in cancer patients was associated with viral anxiety, depression, and maladaptive coping techniques, such as catastrophizing, during the COVID-19 pandemic.

Background/Aims: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. Methods: An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. Results: Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 minutes vs 34.3±8.3 minutes, p<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 mm 2 /min vs 18.1±4.7 mm 2 /min, p<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8%±3.4% vs 35.1%±3.9%, p<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. Conclusions The dissection speed and safety profile improved significantly with the retractable RESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.