OBJECTIVE: This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. METHODS: From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. RESULT: Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). CONCLUSION: Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.
Brain ; Brain Injuries ; Brain Stem ; Consciousness ; Diffuse Axonal Injury ; Glasgow Coma Scale ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Medical Records ; Retrospective Studies

BACKGROUND: We have studied the 67Ga SPECT to determine the activity of pulmonary tuberculosis, especially in patients with minimal extent of the disease on chest radiographs. Because active minimal pulmonary tuberculosis is sometimes difficult to diagnose by means of initial chest X-ray, sputum examination and 67Ga planar imaging, we compared 67Ga planar imaging with SPECT to evaluate minimal pulmonary tuberculosis activity. METHODS: 67Ga planar imagings and SPECTs of 69 patients suspected of minimal pulmonary tuberculosis by the initial chest X-ray were performed and compared to each other. Active pulmonary tuberculosis was defined by a positive AFB smear and/or culture in the sputum and changes shown on the serial chest X-ray findings. RESULTS: 1)67Ga planar imaging imagings showed positive uptakes in 24 patients and no uptakes in 13 patients, which confirms active pulmonary tuberculosis. But SPECT imagings showed positive uptakes in 25 patients and no uptakes in 12 patients. 2) Patients confirmed with inactive pulmonary tuberculosis showed no up-take on 67Ga planar imaging. Only one of the 32 patients confirmed as having inactive pulmonary tuberculosis showed positive uptake on 67Ga SPECT imaging. CONCLUSIONS: According to the results of our study, 67Ga planar imaging and SPECT are both sensitive in detecting the activity of minimal pulmonary tuberculosis. The difference between the two methods is not statistically significant, and the negative predictive value of the 67Ga SPECT is not higher than that of 67Ga planar imaging.
Humans ; Radiography, Thoracic ; Sputum ; Thorax ; Tomography, Emission-Computed, Single-Photon* ; Tuberculosis, Pulmonary*

BACKGROUND: Thalium 201(TI-201) has been a widely applied myocardial perfusion agent for the detection of coronary artery disease. however its low emission energy and long half-life make this agent suboptiomal for the examination of coronary artery disease. To circumvent the physical limitation of TI-201, a group of technetium 99m-labeled isonitril complex has been developed. Our study was done to examine the value of SPECT with 99mTc-HexaMIBI in estimating myocardial perfusion in patients with myocardial infarction. METHODS: We evaluated the sensitivity of SPECT with 99mTc-HexaMIBI in 29 patients with acute myocardial infarction. We also compared the severity and vascular territory of abnormal perfusion on SPECT scanning with severity of coronary artery stenosis, values of serum enzyme and sites in ECG. RESULTS: 1) There were 26 patients(90%) who showed perfusion defect, and 3 patients(10%) who showed normal perfusion in myocardial SPECT. The 3 patients with normal perfusion demonstrated non Q-wave infarction of ECG. 2) Among 23 patients performed coronary argiography, there were 19 patients(82%) who showed positive findings on myocardial SPECT and luminal narrowing above 50% on coronary angiogram, and there were 3 patients(13%) who showed significant coronary artery stenosis in spite of negative myocardial SPECT. 3) The grade of perfusion defect showed no significant difference between groups undergone thrombolytic therapy and groups not undergone thrombolytic therapy. 4) There was good correlation between the site of perfusion defect on SPECT and the site of infarction on ECG. CONCLUSION: We conclude that SPECT with 99mTc-HexaMIBI is a promising non invasive test for simultaneous diagnosis of myocardial infarction and evaluation of perfusion defect.
Coronary Artery Disease ; Coronary Stenosis ; Diagnosis ; Electrocardiography ; Half-Life ; Humans ; Infarction ; Myocardial Infarction* ; Perfusion ; Phenobarbital ; Technetium ; Technetium Tc 99m Sestamibi* ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: Developments in endoscopic technique and equipments have improved duct clearance rate in patients with extrahepatic bile duct(EHBD) stone. In this study, we reviewed our experience in extracting EHBD stones with standard and more advanced technique and equipments such as mechanical lithotripsy and extra corporeal shock wave lithotripsy. Aims of this study were to determine the overall success rate of endoscopic ex tracting for EHBD stone, to identify risk factors for failed duct clearance at initial and final therapeutic ERCP. METHODS: We retrospectively reviewed 214 consec utive patients who underwent Endoscopic Retrograde Cholangiopancreatography(ERCP) for EHBD stone over 45 months period. Factors evaluated for failed duct clearance included stone size, stone number, stone shape, concomitant stone of gallbladder and intrahepatic duct, presence of distal bile duct stricture, periampullary diverticula(PAD), Billroth-II gastrojejunostomy, and sepsis at admission. RESULTS: The overall success rate of endoscopic treatment for EHBD stone was 93.5% (200/214). The causes of failed duct clearance were failed endoscopic sphincterotomy in 5/214 (2.3%), technical failure of extracting stone in 5/214(2.3%), and aggravation of acute cholecystitis between therapeutic endoscopic sessions in 4/214(1.9%). Risk factors for failed duct clearance with endoscopic extraction of EHBD stone were size and shape of the stone, concomitant stone of gallbladder and intra hepatic duct, and stricture of distal common bile duct. The duct clearance rate with initial therapeutic ERCP was 56.5%(121/200). Risk factors for failed duct clearance with initial therapeutic ERCP were size, shape and number of stone, and sepsis at admission. The com plications of endoscopic treatment for EHBD stone were major bleeding in 5/200 (2.5%), pancreatitis in 18/200 (9.0%), but there was no perforation. CONCLUSION: Eventhough risk for failure of endo scopic treatment for EHBD stone were giant or piston shaped stone, concomitant stone of gallbladder and intra hepatic duct, and stricture of distal common bile duct, we conclude that endoscopic treatment for EHBD stone is safe and effective treatment modality, and choice of treatment.
Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis, Acute ; Common Bile Duct ; Constriction, Pathologic ; Gallbladder ; Gastric Bypass ; Hemorrhage ; Hepatic Duct, Common ; Humans ; Lithotripsy ; Pancreatitis ; Retrospective Studies ; Risk Factors ; Sepsis ; Shock ; Sphincterotomy, Endoscopic

BACKGROUND AND OBJECTIVES: Canalith repositioning procedure described by Epley is an effective treatment of benign paroxysmal positional vertigo (BPPV) based on the theory of canalithiasis. Although there are many modifications of Epley's maneuver, they have much similarity and are usually composed of 4 steps. However there is considerable variation of pause at each position from 6 seconds to 4 minutes. The purpose of this study is to determine treatment outcome of short and long pause at each position. MATERIALS AND METHODS: This is a randomized prospective study of patients with posterior canal type BPPV. One hundred patients were randomized to one of two groups at their first clinic visit between March 1999 and September 2000. The diagnosis was based on typical findings of vertigo and nystagmus by Dix-Hallpike maneuver and head turning in supine position. The authors treated patients with two different methods of the canalith repositioning procedure. One group maintained each position until the nystagmus stopped. If no nystagmus was observed, the position was maintained for 5 to 10 seconds. The other group maintained each position for 3 minutes. We assessed treatment outcomes of two methods. RESULTS: We can not find the difference of a success rate between two groups. CONCLUSION: It takes less than one minute with rapid head position changing method, so this method is more feasible in out-patients clinics.
Ambulatory Care ; Diagnosis ; Head ; Humans ; Outpatients ; Prospective Studies ; Supine Position ; Treatment Outcome* ; Vertigo ; Vestibular Diseases

BACKGROUND & OBJECTIVES: Recently many reports suggest the horizontal canal benign paroxysmal positional vertigo (h-BPPV) is not rare. However there have been few reports on physical therapy for horizontal canal cupulolithiasis, while horizontal canal canalithiasis has a relatively well defined and effective therapy. To evaluate the efficacy of different methods of treating horizontal canal cupulolithiasis, we conducted prospective study. METHODS: We enrolled 104 consecutive patients who were diagnosed with h-BPPV. During that period, patients with posterior canal BPPV numbered 112. Patients with h-BPPV were diagnosed when lateral head rotation in the supine position resulted in geotropic or apogeotropic bilateral horizontal nystagmus. In patients presenting with apogeotropic variant (n=40), following maneuvers was performed sequentially. First of all, we performed head shaking and applied vibrator to the mastoid bone to detach otolith from cupula. If they failed to detach otolith from cupula, we performed barbecue rotation and forced prolonged position (FPP). The treatment outcome was considered as responsive when, immediately after each physical therapy, nystagmus shifted from apogeotropic to geotropic or no nystagmus was elicited by provocation test and symptoms of positional vertigo abated. RESULTS: There were 27 women and 13 men from ages 30 to 80 (mean 55) years. The average duration of symptoms before intervention was 0 to 12 (mean 0.6) days. In 4 cases, symptoms resolved spontaneously after provocation test. Of the 36 patients treated with headshaking, 6 were responsive. Of the 30 patients treated with vibrator after failure of head shaking, only 1 were responsive. In the barbecue rotation, none obtained relief after barbecue rotation. Of the 9 patients treated with FPP after failure of the barbecue rotation, 4 were symptom free after FPP. Twenty five patients, including 5 non-responders with FPP, underwent no more rehabilitation maneuver. In most of cases (n=24), horizontal canal cupulolithiasis resolved spontaneously within a week. CONCLUSIONS: The direct effectiveness of physical therapy for horizontal canal cupulolithiasis is largely unsatisfactory. However, in many cases, horizontal canal cupulolithiasis resolved spontaneously in a few days.
Female ; Head ; Humans ; Male ; Mastoid ; Nystagmus, Pathologic ; Otolithic Membrane ; Prospective Studies ; Rehabilitation ; Supine Position ; Treatment Outcome ; Vertigo

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height2) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.
Absorptiometry, Photon ; Accidental Falls ; Aging ; Body Composition ; Bone Density ; Case-Control Studies* ; Female ; Hip Fractures ; Hip* ; Humans ; Korea ; Leg ; Male ; Multivariate Analysis ; Muscle, Skeletal ; Nutrition Surveys ; Osteoporosis ; Prevalence* ; Sarcopenia*

BACKGROUND/AIMS: Therapies involving bone-marrow-derived mesenchymal stem cells (BM-MSCs) have considerable potential in the management of hepatic disease. BM-MSCs have been investigated in regenerative medicine due to their ability to secrete various growth factors and cytokines that regress hepatic fibrosis and enhance hepatocyte functionality. The aim of this study was to determine the antifibrosis effect of BM-MSCs on activated hepatic stellate cells (HSCs) and the mechanism underlying how BM-MSCs modulate the function of activated HSCs. METHODS: We used HSCs in both direct and indirect co-culture systems with BM-MSCs to evaluate the antifibrosis effect of BM-MSCs. The cell viability and apoptosis were evaluated by a direct co-culture system of activated HSCs with BM-MSCs. The activations of both HSCs alone and HSCs with BM-MSCs in the direct co-culture system were observed by immunocytochemistry for alpha-smooth muscle actin (alpha-SMA). The levels of growth factors and cytokines were evaluated by an indirect co-culture system of activated HSCs with BM-MSCs. RESULTS: The BM-MSCs in the direct co-culture system significantly decreased the production of alpha-SMA and the viability of activated HSCs, whereas they induced the apoptosis of activated HSCs. The BM-MSCs in the indirect co-culture system decreased the production of transforming growth factor-beta1 and interleukin (IL)-6, whereas they increased the production of hepatocyte growth factor and IL-10. These results confirmed that the juxtacrine and paracrine effects of BM-MSCs can inhibit the proliferative, fibrogenic function of activated HSCs and have the potential to reverse the fibrotic process by inhibiting the production of alpha-SMA and inducing the apoptosis of HSCs. CONCLUSIONS: These results have demonstrated that BM-MSCs may exert an antifibrosis effect by modulating the function of activated HSCs.
Apoptosis ; Bone Marrow Cells/*cytology ; Cell Differentiation ; Coculture Techniques ; Hepatic Stellate Cells/*cytology/metabolism ; Hepatocyte Growth Factor/metabolism ; Humans ; Immunophenotyping ; Interleukin-10/metabolism ; Interleukin-6/metabolism ; Liver Cirrhosis ; Mesenchymal Stromal Cells/*cytology/metabolism ; Transforming Growth Factor beta1/metabolism

OBJECTIVE: The Korean College of Neuropsychopharmacology developed a Korean treatment algorithm for obsessive-compulsive disorder (OCD) to aid clinical decisions. The goal of this preliminary study was to encourage clinical practitioners to treat patients using cognitive-behavioral therapy. METHODS: We sent a questionnaire to 34 leading experts on OCD to investigate their opinions about treating patients with OCD using cognitive-behavioral therapy. RESULTS: Of the 34 experts, 12 responded to the survey. The responses indicated that most patients with obsessive-compulsive disorder should be offered cognitive-behavioral therapy, incorporating intensive and sufficient cognitive therapy with response prevention. CONCLUSION: These results may provide information about the application of cognitive-behavioral therapy to treat obsessive-compulsive disorder.
Cognitive Therapy ; Humans ; Obsessive-Compulsive Disorder* ; Surveys and Questionnaires

OBJECTIVE: The Korean College of Neuropsychopharmacology developed a Korean treatment algorithm for obsessive-compulsive disorder (OCD) to aid clinical decisions. The goal of this preliminary study was to encourage clinical practitioners to treat patients using cognitive-behavioral therapy. METHODS: We sent a questionnaire to 34 leading experts on OCD to investigate their opinions about treating patients with OCD using cognitive-behavioral therapy. RESULTS: Of the 34 experts, 12 responded to the survey. The responses indicated that most patients with obsessive-compulsive disorder should be offered cognitive-behavioral therapy, incorporating intensive and sufficient cognitive therapy with response prevention. CONCLUSION: These results may provide information about the application of cognitive-behavioral therapy to treat obsessive-compulsive disorder.
Cognitive Therapy ; Humans ; Obsessive-Compulsive Disorder* ; Surveys and Questionnaires