Vascular dementia is one of the few remediable causes of dementia among the eldery. Prevention of the disease can be best achieved by primary or secondary prevention of controllable risk factors for strokes. Therefore, early and accurate diagnosis of vascular cognitive impairment prior to the dementia stage is essential to the prevention and treatment of vascular dementia. Pharmacological and non-pharmacological methods for prevention of vascular dementia are listed in this article. Recent epidemiologic data, suggesting a direct correlation between vascular risk factors and Alzheimer type dementia, emphasized the importance of controlling vascular risk factors in the prevention of dementia. Treatment strategies for patients diagnosed as vascular dementia are also discussed. Several clinical trials for symptomatic improvement of vascular dementia are ongoing and their success can be a hope to patients with vascular dementia.
Alzheimer Disease ; Cognition Disorders ; Dementia ; Dementia, Vascular* ; Diagnosis ; Hope ; Humans ; Risk Factors ; Secondary Prevention ; Stroke

Clear cell sarcoma of tendons and aponeuroses is the term coined by Enzinger in 1965 to describe a rare but unique type of soft tisse neoplasm whose cells characteristically have the capacity to produce melanin. The authors experienced a case of 64-year old female who presented with a 6x5x4 cm sized mass deeply seated in the left popliteal fossa. The mass was firm and multinodular, and on cut section revealed patches of brown black pigmentation. Histologically the tumor was composed of round to fusiform cells with clear or pale eosinophilic cytoplasm that contained small amounts of glycogen, separated into compact nests or short fascicles by delicate septa of fibrous tissue. The brown black pigment seen in tumor cells and stroma was proven to be melanin by special stain, and ultrastructural examination showed melanosomes in varying stages of development dispersed freely in the cytoplasm or in the lysosomes. These findings strongly support the view that clear cell sarcoma is a tumor of neural crest origin rather than of tenosynovial mesenchyme origin, and is a soft tissue variant of malignant melanoma.
Female ; Humans

We present a case of pemphigus vulgaris developed during pregnancy. The clinical features of this patient were similar to those of hetpes gestationis. By immunofluorescence studies we found that the patient's serum contained autoantibodies to intercellular substance of epidermis. Direct immunofluorescence microscopy of a perilesional skin also demontrated immunoglobulin deposition in the intercellular areas. Additionally we did in vitro C3 staining for further confirmation of the diagnosis but it was negative in basement membrane zone. This patient was initially treated with corticosteroid and azathioprine. Several months later gold compound was given instead of azathioprine and corticosteroid with good therapeutic response.
Autoantibodies ; Azathioprine ; Basement Membrane ; Diagnosis ; Epidermis ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulins ; Microscopy ; Pemphigus* ; Pregnancy* ; Skin

Congenital cystic adenomatoid malformation of the lung is a rare form of congenital cystic disease of the lung and associated with developmental arrest of bronchioles in embryonic life. We report 3 cases of congenital cystic adenomatoid malformation which are classified as type I, II and III according to the morphological classification by Stocker et al. The first case was a 6-year-old female with a mass in the lower lobe of the right lung. The mass was composed of several cysts which were filled with inflammatory exudate and lined by ciliated pseudostratified columnar epithelium (type I + II). The second case was a 4-year-old female with a mass in the middle lobe of the right lung. It was composed of numerous small cysts which were uniform sized and contained inflammatory exudate. These were lined by ciliated columnar and pseudostratified columnar epithelium (type II). The third case was a stillborn female at 27 weeks of gestation. There was generalized edema and severe ascites. The left lower lobe consisted of an ill-defined solid area and small cysts. The solid lesion was composed of bronchiole-sized cysts lined by non-ciliated cuboidal epithelium (type II + III).
Female ; Humans ; Cysts

The present study is aimed to investigate the clinical and pathologic features of GI lymphomas and the immunocytochemical characteristics, using 71 cases of primary GI lymphomas examined at the Department of Pathology, Yonsei University College of Medicine, Youngdong Serverance Hospital and Yonsei University Wonju College of Medicine from January, 1976 to December, 1985. Results obtained were as follows: 1) Sixty eight cases were Non-Hodgkin's lymphoma and 3 Hodgkin's lymphoma. Surgical resection was done in 58 patients and surgical biopsy in 13. 2) The primary sites of the tumors were stomach, small intestine, ileocecal area and large intestine in a descending order of frequency. 3) The mean age at the time of diagnosis was 45 years. The tumor of the small intestine was generally detected in the younger age and that of the large intestine in the older age. The overall male to female ratio was 1.9 : 1. 4) Abdominal pain was the most common presenting symptom irrespective of the sites of the tumor. Duration of the symptoms were evenly distributed from hours to 12 monthes. 5) The size of the tumors was less than 10 cm in the largest dimension in most of the cases (79.3%). The gross types of the GI lymphomas were ulcerative (27.6%), polypoid (20.7%), multinodulated (17.2%) and diffuse thickening. The rate of lymph node involvement was 44.4% in tumors confined to the serosa, while 82.6% in tumors with serosal penetrations. 6) Classification of 68 cases of Non-Hodgkin's lymphoma according to Working Formulation revealed 50 cases of intermediate grade, 13 cases of high grade and 5 cases of low grade. According to Rappaport classification, all were diffuse types, among which diffuse histiocytic type was the most common. According to Lukes-Collins classification, 60 cases were B cell types, 4 cases genuine histiocytes types and 3 cases T cell types. Most of the gastric and intestinal lymphomas belonged to the follicular center cell (small and large cleaved, large cleaved) types. 7) Immunoperoxidase stains were done in 55 cases of malignant lymphomas. Thirty (65.9%) of 47 B cell lymphomas revealed a positivity for B cell markers. Twenty three (48.9%) of them showed a monoclonality, in which kappa/IgG pattern was most frequently demonstrated. Four cases of true histiocytic lymphomas were positive for alpha-1-antichymotrypsin and lysozyme, the former of which was seemed to be a more sensitive marker for histiocytic differentiation. An attempt was made to evaluate the significance of the degree of reactive histiocytic infiltrates within the lymphoma in relation to the progosis, but correlation could not be made because of the limited cases.
Female ; Male ; Humans ; Biopsy

BACKGROUND AND OBJECTIVES: Pemphigus is an autoimmune bullous disease of the skin and mucous membranes. There are two major types of pemphigus, namely pemphigus vulgaris(PV) and pemphigus foliaceus(PF) which can be classified by the specificity of the autoantibodies against the epidermal desmosomal antigens in this disease. Like many other autoimmune diseases, pemphigus is also considered to be strongly associated with certain HLA alleles; some alleles can be detected with higher frequencies as compared with those found in ethnically matched populations. At this time, we tried to find out if there were certain HLA class II allele(s) associated significantly with Korean patients of pemphigus. PATIENTS AND METHODS: Thirty patients with pemphigus (fifteen of PV and fifteen of PF), and one hundred healthy Korean controls were enrolled in this study. For the genotyping of HLA class II alleles in DRB1 loci, genomic DNAs prepared from buccal epithelia were amplified by polymerase chain reactions with nucleotide sequence-specific primers. Each allele of thirteen different generic types belonging to the DRB1 loci were used to identify the existence of each allele in both patient and control groups on gel electrophoreses. RESULTS: In PV, there was a significantly increased frequency of HLA-DRB1*01 alleles than from the findings observed in the controls(pc=0.0013, RR:5). In patients with PF, there was a significant degree of association with HLA-DRB1*01(pc=0.00013, RR:5.5) when compared with that in normal controls. However, no allele of negative association with a significantly low frequency in the patient group was detected in both types of the disease. CONCLUSION: It can be suggested that DRB1*01 alleles may be susceptibility genes in Korean patients with PV, and DRB1*01 alleles could contribute to the autoimmune reactivity in patients with PF. This data shows different patterns in the frequency of each DRB1 allele in patient groups compared with those found in patients of other ethnic backgrounds.
Alleles* ; Autoantibodies ; Autoimmune Diseases ; DNA ; Electrophoresis ; HLA-DRB1 Chains* ; Humans ; Mucous Membrane ; Pemphigus* ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Skin

PURPOSES: We analysed the five-year outcomes and associated complications of transscleral diode laser photocoagulation (TSDLP), used to treat acute proliferative retinopathy of prematurity (ROP), to evaluate the efficacy and safety of this therapy. METHODS: We performed a retrospective analysis of the records of 163 eyes of 82 infants with acute ROP, who were treated with TSDLP by a single surgeon. Follow-up periods ranged from 15 to 278 weeks. RESULTS: The outcome was favorable in 158 eyes (96.9%) and unfavorable in 5 eyes (3.1%) of the 163 eyes that were treated. Vitreous hemorrhage was found to be an indicator of poor prognosis. Of the complications noted, symblepharon was observed in three eyes, hyphema was observed in four eyes, and a complicated cataract was observed in one eye. CONCLUSIONS: The results suggest that TSDLP is a safe and effective in the treatment of ROP. Vitreous hemorrhage should be regarded as a sign of poor prognosis.
Cataract ; Follow-Up Studies ; Humans ; Hyphema ; Infant ; Lasers, Semiconductor* ; Light Coagulation* ; Prognosis ; Retinopathy of Prematurity* ; Retrospective Studies ; Vitreous Hemorrhage

PURPOSE: To investigate the short-term efficacy and safety of ranibizumab in the routine clinical setting in patients with neovascular age-related macular degeneration and to analyze the associated factors for visual outcome. METHODS: This was a post-hoc analysis of a ranibizumab regulatory post-marketing surveillance study in which 4,136 patients were enrolled and followed for 12 weeks. Change in best-corrected visual acuity (BCVA), size of choroidal neovascularization, and the presence of hemorrhage and exudate were analyzed and the association between BCVA change and baseline characteristics were investigated. Data on ocular and systemic adverse events were collected. RESULTS: Mean BCVA improved significantly and mean BCVA change was the logarithm of the minimal angle of resolution 0.13 ± 0.01 (p < 0.001). A lower baseline BCVA and younger age were significant predictive factors for visual improvement or maintenance (≥0 lines). For greater visual acuity gain (≥3 lines), no treatment history, lower baseline BCVA, younger age, and classic-type choroidal neovascularization were significant predictive factors. No new safety signals were found. CONCLUSIONS: In this study, conducted in real-world clinical practice with a large number of neovascular age-related macular degeneration patients, visual and anatomical outcomes improved significantly after three monthly ranibizumab treatments. Treatment-naive patients had a higher chance of greater visual gain (≥3 lines) than non-naive patients.
Choroidal Neovascularization ; Exudates and Transudates ; Hemorrhage ; Humans ; Macular Degeneration ; Ranibizumab ; Visual Acuity

A case of multiple hamartomas of the unilateral chest wall in a four month old infant is presented. There have been a few reports on the CT findings of the chest wall hamartoma in infancy. We describe bone changes of the ribs and mineralization of this rare tumor on the CT scan, and the locations of two separate masses.
Hamartoma ; Humans ; Infant ; Miners ; Ribs ; Thoracic Wall* ; Thorax* ; Tomography, X-Ray Computed

BACKGROUND & OBJECTIVES: Subacute combined degeneration (SCD) is a disease of spinal cord involving the posterior and lateral column due to vitamin B12 deficiency. The clinical and electrophysiologic findings of SCD are various. METHODS: From 1989 to 1996, 7 patients were diagnosed with SCD in our hospitals. The diagnosis was made by the neurologic and laboratory findings and electrophysiolgic studies such as nerve conduction studies(NCS) and evoked potential(EP). RESULT: Four patients received gastrectomy. Two had chronic atrophic, gastritis; one of them was assumed to have food-cobalamin malabsorrtion. The remaining one was a heavy drinker. The mean duration of neurologic symptoms was 35.7 months. The most common initial complaint was paresthesia (in 4) and impairment of cutaneous sensation was the most common neurologic sign At the time of diagnosis, 5 patients had myelopathy with was supported by EP in 3(60%). There were abnormal NCS findings in 5 f 6 patients with peripheral neuropathy. In one patient, there was no symptom and sign compatible with myelopathy but median nerve SEP showed bilateral central conduction delay. No one had visual symptoms but prolongation of P 100 was detected in 2 patients. Sural nerve biopsy was done in 2 case, which revealed chronic nonspecific neuropatby in one and chronic axonopathy in the other. Megaloblastic anemia was found in 4 cases and improved by cobalamin therapy in all the parents, in which the follow up hematologic data were available. There as a tendency that nonanemic patients had more severe neurologic symptoms than anemic ones. We could not find any relationship between the duration and severity of neurologic menifestations was best in the patients with the shortest duration of neurologic manifestations and hematologic feature festations. CONCLUSIONS: The authors suggest that early detection and treatment is very important for the improvement of symptoms in SCD.
Anemia, Megaloblastic ; Biopsy ; Diagnosis ; Follow-Up Studies ; Gastrectomy ; Gastritis ; Humans ; Median Nerve ; Neural Conduction ; Neurologic Manifestations ; Parents ; Paresthesia ; Peripheral Nervous System Diseases ; Sensation ; Spinal Cord ; Spinal Cord Diseases ; Subacute Combined Degeneration* ; Sural Nerve ; Vitamin B 12 ; Vitamin B 12 Deficiency