Objective: To investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients. Methods: Sixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments. Results: The initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients. Conclusion Aphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

OBJECTIVE: To investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI). METHODS: Eighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated. RESULTS: There were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks. CONCLUSION: The results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI.
Acoustics ; Asthenia ; Brain Injuries* ; Deglutition ; Deglutition Disorders* ; Dysphonia* ; Electric Stimulation Therapy ; Electric Stimulation* ; Humans ; Phonation ; Pilot Projects* ; Stroke

PURPOSE: It is known that carriage rates of Staphylococcus aureus (S. aureus) are highest in newborns and that the asymptomatic carriage of methicillin-resistant Staphylococcus aureus (MRSA) is associated with invasive MRSA infection with the colonizing strain. This study was carried out to investigate the carriage rates of MRSA in neonates with neonatal jaundice. METHODS: We reviewed the medical records of 545 neonates admitted with neonatal jaundice to neonatal intensive care units between January 2006 and December 2010. Nasal and inguinal swab specimens had been taken from them and cultured for the isolation of S. aureus. Antimicrobial susceptibility tests had been done for such isolates to determine methicillin-resistance. RESULTS: Out of 545 neonates, 318 (58.3%) were colonized with S. aureus and 214 (39.3%) were colonized with MRSA. Results of the antibiogram analysis showed that 65.7% of MRSA isolates were likely to be community-associated (CA) MRSA. CONCLUSION: Based on the MRSA carriage rate of 39.3%, a surveillance program for MRSA colonization is considered necessary in neonates transferred from other clinics or hospitals. Out of MRSA isolates, 65.7% were likely to be CA-MRSA. This suggests that CA-MRSA strains were already present in obstetric clinic environments where the neonates were born. It is thought that MRSA surveillance programs in these environments are also necessary.
Colon ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Jaundice, Neonatal ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Sprains and Strains ; Staphylococcus aureus

BACKGROUND: Coronary stenting is one of effective and well-accepted treatments for coronary artery disease. On the other hand, side branch occlusion (SBO) is a known complication of percutaneous transluminal coronary angioplasty (PTCA) and coronary stenting. Accordingly, this study was designed to determine the incidence, predictors and acute clinical outcomes of SBO. METHODS: Coronary angiographic findings of 45 patients who had total 98 side branches originating from the stented segments were analized before and just after coronary stenting. Bifurcation lesions were divided into 3 types : type 1, type 2, type 3 and each type was subdivided into type A with significant ostial narrowing (diameter stenosis >or=50%) and type B without significant ostial narrowing of side branches. Side branch occlusion was defined as development of total occlusion or morphologic changes from type B to type A or reduction of TIMI flow more than grade 1 compared with pre-stenting flow of side branches. RESULTS: After coronary stenting, SBO occurred in 20 of 98 side branches (20.4%). SBO was significantly related with history of previous myocardial infarction (p=0.02), threatened side branch morphology (p=0.016) and poor pre-stenting flow of side branches (p=0.014). There were no serious clinical events such as myocardial infaction and death associated with acute SBO. CONCLUSION: Acute SBO can be developed in a few stented patients. Signifiant clinical and angiographic predictors of SBO just after coronary stenting were the history of previous myocardial infarction, threatened side branch morphology and poor pre-stenting flow of side branches.
Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Stenosis ; Hand ; Humans ; Incidence ; Myocardial Infarction ; Stents*

BACKGROUND: Definite criteria for determining severity of organophosphate poisoning have not been made. Discovery of the third neuromuscular syndrome, the intermediate syndrome, have made it more complicating then ever. Objectives of this study is to determine early prognostic factors of outcome and development of a new treatment algorithm. METHOD: 74 patients admitted to Severance hospital with acute organophosphate poisoning during 5 years were included. We made a protocol concerning the initial consciousness level, QTc interval, PVC, serum cholinesterase, the intermediate syndrome, total hospital, ICU day, length of ventilator support, disposition and have done a study retrospectively. Multiple regression and Chi-square was used as statistical analysis. Significant statistical P-value was 0.05. RESULTS: The total hospital days were prolonged as serum cholinesterase levels were lower, the age was older and mental status graver.(p<.05) The length of ventilatory support was prolonged when patient's serum cholinesterase level was very low, they were unconscious and serum cholinesterase level not recovered to 500 IU/ml within initial 3 days. The intermediate syndrome was significantly related to the prolonged cholinesterase inhibition. CONCLUSION: As an early prognostic factor for the length of ventilatory support in organophosphate poisoning, 1) level of concsiousness and 2) serum cholinesterase level at admission, 3) recovery to more than 500 IU/ml within initial 3 days are useful. Especially when the serum cholinesterase level is not recovered to more than 500 IU/ml within initial 3 days, it is essential to observe closely for the possibility of an intermediate syndrome.
Cholinesterases ; Consciousness ; Humans ; Organophosphate Poisoning* ; Retrospective Studies ; Ventilators, Mechanical

Candida was found in the oral cavity, jejunum, and ileum of the healthy population. In case of alimentary tract, the factors of favorable to candida colonization include old age, malnutrition, diabetes, burns, trauma, surgical operations, parenteral nutrition, intravascular or bladder catheterization, H2-blocker therapy, steroid therapy, immunosuppresive treatment and the use of wide spectrum antibiotics: however, gastrointestinal candida colonization is rarely found in the healthy adult. No case of duodenal ulcer with candidiasis has been reported in healthy people. Recently we experienced a case of asymptomatic duodenal ulcer with candidiasis in a healthy male, who had taken H2-blocker and proton pump inhibitor for 3 months after primary closure of duodenal ulcer perforation. Therefore we report this case with review of several literatures.
Adult ; Anti-Bacterial Agents ; Burns ; Candida ; Candidiasis* ; Catheterization ; Catheters ; Colon ; Duodenal Ulcer* ; Humans ; Ileum ; Jejunum ; Male ; Malnutrition ; Mouth ; Parenteral Nutrition ; Proton Pumps ; Urinary Bladder

PURPOSE: This study was undertaken to eveluate the early results of the laparoscopic suture rectopexy in the treatment of rectal prolapse. METHODS: From May 1999 to July 2001, laparoscopic suture rectopexy (LSR) was successfully performed in 26 patients and the results were compared to those of 5 patients with open suture rectopexy (OSR) and 6 patients with open resection rectopexy (ORR). Preoperative and postoperative functional assessment included Wexner's incontinence score, constipation score, and anorectal manometry. RESULTS: Immediate postoperative morbidity was minimal in all groups. Bowel function was resumed significantly sooner (P=0.001), the numbers of the analgesics injection were significantly fewer (P<0.001) and postoperative hospital stay was significantly shorter (P<0.001) in the LSR than in the open groups. Postoperatively, the anal resting and squeezing pressures increased slightly and Wexner's incontinence score decreased significantly in all groups of patients. Constipation score decreased slightly in all groups of patients after surgery. There was one mucosal prolapse recurrence after surgery in the LSR. CONCLUSIONS: Laparoscopic suture rectopexy for rectal prolapse can be performed safely. Recovery is uneventful and of shorter duration after the laparoscopic than after the open approach. Functional results are obtained similarly with both approaches.
Analgesics ; Constipation ; Humans ; Length of Stay ; Manometry ; Prolapse ; Rectal Prolapse* ; Recurrence ; Sutures*

OBJECTIVE: To delineate cervical radiculopathy that is found in combination with traumatic cervical spinal cord injury (SCI) and to determine whether attendant cervical radiculopathy affects the prognosis and functional outcome for SCI patients. METHODS: A total of 66 patients diagnosed with traumatic cervical SCI were selected for neurological assessment (using the International Standards for the Neurological Classification of Spinal Cord Injury [ISNCSCI]) and functional evaluation (based on the Korean version Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]) at admission and upon discharge. All of the subjects received a preliminary electrophysiological assessment, according to which they were divided into two groups as follows: those with cervical radiculopathy (the SCI/Rad group) and those without (the SCI group). RESULTS: A total of 32 patients with cervical SCI (48.5%) had cervical radiculopathy. The initial ISNCSCI scores for sensory and motor, K-MBI, and total FIM did not significantly differ between the SCI group and the SCI/Rad group. However, at discharge, the ISNCSCI scores for motor, K-MBI, and FIM of the SCI/Rad group showed less improvement (5.44+/-8.08, 15.19+/-19.39 and 10.84+/-11.49, respectively) than those of the SCI group (10.76+/-9.86, 24.79+/-19.65 and 17.76+/-15.84, respectively) (p<0.05). In the SCI/Rad group, the number of involved levels of cervical radiculopathy was negatively correlated with the initial and follow-up motors score by ISNCSCI. CONCLUSION: Cervical radiculopathy is not rare in patients with traumatic cervical SCI, and it can impede neurological and functional improvement. Therefore, detection of combined cervical radiculopathy by electrophysiological assessment is essential for accurate prognosis of cervical SCI patients in the rehabilitation unit.
Classification ; Electrophysiology ; Follow-Up Studies ; Humans ; Patient Outcome Assessment ; Prognosis* ; Radiculopathy* ; Rehabilitation ; Spinal Cord Injuries*

Annuloaortic ectasia, cystic medial degeneration of the afflicted aortic wall leading to progressive dilatation, is often accompanied by Marfan's syndrome. Some portions of intimal flap is commonly demonstrated along the aorta in the noninvasive diagnosis of aortic dissection. We report the first case of circumscribed aortic dissection developed in a 28 year old obese non-Marfanoid patient. He was transferred after thrombolytic therapy at a community hospital because of severe chest pain and ST segment elevation. Transthoracic echocardiography showed markedly dilated aortic root, moderate amount of pericardial effusion, mild aortic regurgitation in spite of normal regional wall motion of left ventricle. Intimal flap, characteristic of aortic dissection, was not seen with computed tomography. Intimal tear was demonstrated just above aortic valve only by transesophageal echocardiography. Two parallel intimal tear and small circumscribed dissection was demonstrated by autopsy.
Adult ; Aorta ; Aortic Valve ; Aortic Valve Insufficiency ; Autopsy ; Chest Pain ; Diagnosis ; Dilatation ; Dilatation, Pathologic* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Ventricles ; Hospitals, Community ; Humans ; Marfan Syndrome ; Pericardial Effusion ; Thrombolytic Therapy

In herpes zoster infection, neurological complications may be overlooked because pain is a more prominent symptom and because peripheral polyneuropathy associated with weakness is rare. A 57-year-old male visited our hospital, complaining of pain and skin eruptions on the right flank. He was diagnosed as having herpes zoster and the symptoms were alleviated by administration of acyclovir for a week. After three weeks, the herpes zoster relapsed. He was re-admitted and diagnosed with chronic myeloid leukemia (CML), and imatinib mesylate was prescribed for five weeks. Ten weeks after the onset of herpes zoster, bilateral foot drops and numbness of the right foot dorsum developed. Through an electrodiagnostic study, he was diagnosed as having peripheral polyneuropathy that was suspected to be caused by neural invasion by varicella zoster virus. After administration of famciclovir, not only the pain but also the neurologic symptoms improved. We herein report a case of peripheral polyneuropathy that was supposed to be related to herpes zoster.
2-Aminopurine ; Acyclovir ; Benzamides ; Foot ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Hypesthesia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Male ; Mesylates ; Middle Aged ; Neurologic Manifestations ; Piperazines ; Polyneuropathies ; Pyrimidines ; Skin ; Imatinib Mesylate