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

In the classical ballet dancers, ankle joints are frequently overused. Especially the Pointe and the Releve are the two basic steps of ballet dance which cause the narrowing of the posterior aspect of the ankle joint. Posterior impingement syndrome of the ankle joint is defined as impingement occuring at the anatomical interval between the posterior tibial articular surface and os calcis. The purpose of this study is to describe the anatomy and etiology of this injury and to review the non-operative and operative treatments. Sixteen cases of posterior impingment syndrome had been treated between March 1994 and March 1995. Ten dancers were professional and six were students. The patients was divided 3groups by etiologic factor. Group 1 is anatomical problem factor, Group 2 is overuse factor and Group 3 is ankle sprain factor. Thirteen dancers (81.2%) improved with conservative treatment including local steroid injection. Among the other three dancers, operation was performed in one case. The other two cases stopped dancing. The result was good in one dancer after operation. In the classic ballet dancers, posrerior impingement syndrome was frequent disorder and major etiologic factors are anatomical problem and overuse. Operation was necessary in only group l. It is good result in conservative treatment and operation.
Ankle Injuries ; Ankle Joint* ; Ankle* ; Dancing ; Humans

Flexor hallucis longus tendinitis is a common overuse syndrome in classic ballet dancers. To describe the clinical symptoms, diagnosis and non-operative and operative treatment, we evaluated twenty ballet dancers from march 1994 to August 1995. For the diagnosis, Tomasen test was helpful clinically and MRI was essential for surgical intervetion to find a tendon degeneration. Patients were classified into three groups by symptoms and clinical stages. All of the Group 1 and 2 were recovered by means of the conservative treatment. Two dancers belongs to Group 3 showed a severe degeneration of tendon on the MRI scan, finally was taken the an operation. Release of the tarsal tunnel were performed. Six months after operation, they could return to dancing.
Cumulative Trauma Disorders ; Dancing ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Tendinopathy* ; Tendons

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

Respiratory syncytial virus (RSV) and Influenza virus are the most common pathogen for causing severe upper respiratory infection in all age groups. A multiplex reverse transcription polymerase chain reaction (RT-PCR) has been developed to detect and subtype influenza A (H3N2 and H1N1), B virus and RSV simultaneously in one tube reaction. Amplification with primers derived from conserved sequences within the nucleocapsid for RSV and hemagglutinin subunit for Influenza A (H3N2 and H1N1) and B viruses yielded a 384 bp, a 300 bp, a 236 bp and a 151 bp, respectively. Assay specificity was confirmed by pulse field gel electrophoresis and autosequencing method. Assay sensitivity was 3 PFU/ml of RSV, 22 PFU/ml, 45 PFU/ml of Influenza type A (H3N2 and H1N1) and 6.6 PFU/ml of Influenza B virus by plaque assay. A rapid and sensitive detection method of a one-tube with multiplex RT-PCR capable of identifying more than one viral template as well as synchronizing reverse transcription and PCR had the potential to produce considerable savings of time and cost effectiveness in the diagnostic laboratory.
Conserved Sequence ; Cost-Benefit Analysis ; Electrophoresis ; Hemagglutinins ; Herpesvirus 1, Cercopithecine ; Humans* ; Income ; Influenza B virus ; Influenza, Human* ; Nucleocapsid ; Orthomyxoviridae* ; Polymerase Chain Reaction* ; Respiratory Syncytial Virus, Human* ; Respiratory Syncytial Viruses ; Reverse Transcription* ; Sensitivity and Specificity

BACKGROUND: Knowing the magnitude of a problem is the first step to improving it, and quantifying the health- related quality of life (HRQOL) allows us to do it with respect to stroke. To identify the HRQOL in patients with ischemic stroke and its affecting factors, and compare it with other clinical and functional scales. METHODS: A consecutive series of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) was recruited. Their HRQOL and utilities were assessed using the EQ-5 Dindex-which evaluates the health profile of an individual in five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression) and three levels (no problem, some/moderate problems, and extreme problems)-at 1 year after stroke. The Modified Rankin Scale (MRS), Barthel Index (BI), and NIH Stroke Scale (NIHSS) were used to measure clinical and functional statuses. The EQ-5D index and the clinical and functional statuses were compared by clinical parameters, and the relationships among those scales were examined. Additionally, the EQ-5D index in the patients was compared with that in age- and sex-matched healthy controls. RESULTS: Among 538 patients with AIS or TIA, 465 patients (males, 59.8%; age, 65.3+/-11.8 [mean+/-SD]; TIA, 7.7%; and initial NIHSS, 4.5+/-5.1) were evaluated. The EQ-5D index and the clinical and functional statuses were clearly aggravated by age, but did not differ with most of the risk factors. The EQ-5D index was strongly and significantly correlated with scores on the MRS, BI, and NIHSS. The EQ-5D index was lower in patients (especially older ones) than in healthy controls. CONCLUSIONS: This study shows that the EQ-5D is a feasible and valid tool for measuring HRQOL in patients with AIS or TIA.
Humans ; Ischemic Attack, Transient ; Quality of Life ; Resin Cements ; Risk Factors ; Self Care ; Stroke ; Weights and Measures

Serous cystadenoma of the pancreas, also known as microcystic adenoma or glycogen-rich cystadenoma, is an unusually benign tumor. It is usually large and composed microscopically of many small cysts lined by small, cuboidal or flattened cells containing abundant glycogen. It has been suggested that serous cystadenoma probably arise from the ductular cells or centroacinar cells. Herein, we report on a case of serous cystadenoma of the pancreas in a 55-year-old female. The tumor, measuring 13.5x11.5x10.0 cm, was located in the head of the pancreas and the cut surface revealed a sponge-like appearance due to innumerable tiny cysts containing clear serous fluid. Microscopic analysis showed cystic spaces lined by cuboidal cells with intracytoplasmic glycogen.
Female ; Humans ; Cysts ; Adenoma

No abstract available.
Seizures*

RATIONALE: Studies on ictal SPECT as a method of presurgical evaluation in neocortical epilepsy have been rare and inadequate. We evaluated the accuracy in the localization of epileptic foci with ictal SPECT in neocortical epilepsy and tried to find out the determining factors of its accuracy. METHODS: We performed ictal SPECT 66 times with 99m-Tc-HMPAO in 56 patients, who received video-EEG monitoring and had electroclinical features of neocortical epilepsy. Invasive monitoring was performed in 28 patients & epileptic surgery was done in 31. Their results were also used to help determine the location of epileptic foci. In 54 of 66 scans data about injection time and temporal relationship of HMPAO injection to the onset and secondary generalization of seizures were available. RESULTS: Frontal lobe epilepsy(FLE) was most common(35%) followed by lateral temporal lobe epilepsy(28%), occipital lobe epilepsy(11%), parietal lobe epilepsy(9%), and etc. Ictal SPECT demonstrated unilateral hyperperfusion in 53 of 66 scans (80.3 %) which were concordant with electroclinical lateralization in 48 of 53 (90.6 %). Localized hyperperfusion was evident in 42 of 66 scans (63.6 %) which were concordant with electroclinical localization in 33 of 42(78.6 %). Correctly localized hyperperfusion or correctly-lateralized but diffuse hyperperfusion were detected in 37 of 54 scans in which data about injection time were available. The mean injection time was 32.1 seconds. In 16 scans ictal SPECT showed no hyperperfusion or falsely localized/lateralized hyperperfusion. Their mean injection time was 41.6 seconds. The difference of injection time between two groups was not significant(p-value=0.07), but there was a tendency that the mean injection time of the former group was earlier than that of the latter group. We had chances to perform ictal SPECT repeatedly in 8 patients under the similar conditions. The fact that earlier injection improved the accuracy of ictal SPECT in 6 patients supports the importance of early injection. In 48 studies with ictal injection, only 11 scans gave no or incorrect information of the localization or lateralization of epileptic foci. But, in 6 studies with postictal injection, 5 scans was not helpful. The difference between two groups was statistically significant(p<0.05). The presence of focal lesion, the location of epileptic foci, or secondary generalization did not influence the accuracy of ictal SPECT. CONCLUSIONS: Our data suggest that ictal SPECT in neocortical epilepsy is useful in localization of epileptic foci. Whether injected ictally or postictally and the injection time from seizure onset seems to influence the accuracy of ictal SPECT in neocortical epilepsy.
Epilepsy ; Frontal Lobe ; Generalization (Psychology) ; Humans ; Occipital Lobe ; Parietal Lobe ; Seizures ; Technetium Tc 99m Exametazime ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Humans ; Hyperthyroidism* ; Procollagen*