BACKGROUND AND PURPOSE: The most important treatment for subcortical vascular dementia (SVaD) is controlling the blood pressure (BP). However, the few studies that have investigated the relationships between diurnal BP rhythm and subcortical ischemic vascular cognitive impairment have produced inconclusive results. In the study presented here, the 24-hour BP values of three groups of subjects-patients with subcortical vascular mild cognitive impairment (SvMCI), patients with SVaD, and normal controls-were compared using working criteria and 24-hour ambulatory BP (ABP) monitoring. METHODS: The subjects (42 patients with SVaD, 37 patients with SvMCI, and 30 controls) were selected according to the study's inclusion/exclusion criteria. All subjects underwent brain magnetic resonance (MR) imaging and MR angiography, detailed neuropsychological testing, and 24-hour ABP monitoring. RESULTS: The prevalence of nondippers differed markedly between the control group and both the SVaD and SvMCI groups. Loss of nocturnal dipping was significantly associated with SVaD [odds ratio (OR), 4.827; 95% confidence interval (CI), 1.07-12.05]. CONCLUSIONS: It was found that SVaD is associated with loss of nocturnal BP dipping combined with increased pulse pressure and systolic BP (SBP) variability. Correction of these factors could therefore be important in the prevention of SVaD, independent of measures used to reduce BP.
Angiography ; Blood Pressure ; Brain ; Dementia, Vascular ; Humans ; Magnetic Resonance Spectroscopy ; Mild Cognitive Impairment ; Neuropsychological Tests ; Prevalence

OBJECTIVE: The aim of this study was to investigate the correlation between crossed cerebellar diaschisis (CCD) and motor evoked potentials (MEPs) and to study the relationship between CCD and the severity and prognosis of stroke. METHOD: 28 patients with first-ever unilateral stroke were recruited for this study. The central motor conduction times (CMCTs) were obtained from Abductor pollicis brevis (APB) and Abductor hallucis (AH) by recording MEPs. The existence of CCD was evaluated by single photon emission computed tomography (SPECT) of brain. The National Institutes of Health stroke scale (NIHSS), Motricity Index (MI), and functional outcome scales were measured. RESULTS: The presence of CCD correlated significantly with "not evoked" MEPs in upper extremity (p <0.01). The existence of CCD was not associated with the locations (p> 0.05) and volume of brain lesion (p> 0.05). There was a significant correlation between the presence of CCD and lower MI score of upper extremity (p <0.05). CONCLUSION: The presence of CCD would indicate the damage on descending motor pathways and be associated with the severe motor impairment of upper extremity in stroke patients.
Brain ; Efferent Pathways ; Evoked Potentials, Motor ; Humans ; National Institutes of Health (U.S.) ; Prognosis ; Stroke* ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity* ; Weights and Measures

Schwartz-Jampel syndrome is a rare autosomal recessive disorder characterized by clinical myotonia, persistent spontaneous activity, and skeletal dysplasia (short stature, pigeon breast, micrognathia etc.). We experienced an eleven- year-old girl complaining of gait disturbance and motor weakness of both legs. She was operated for umblical hernia at the age of two and for congenital hip dislocation at the age of six. She displayed short stature, short neck, microstomia, micrognathia, pigeon breast, and calf muscle hypertrophy. Her muscle strength was fair to good grade in both legs. Percussion- and exercise-induced myotonia was observed. Her cognitive function was below-average intelligence. Serum creatine kinase was elevated three to four times of normal level. Routine motor and sensory conduction studies were normal and continuous electrical myotonic discharges were detected in all examined muscles. Clinically, her symptom was non-progressive for three years.
Breast ; Columbidae ; Creatine Kinase ; Female ; Gait ; Hernia ; Hip Dislocation, Congenital ; Humans ; Hypertrophy ; Intelligence ; Leg ; Microstomia ; Muscle Strength ; Muscles ; Myotonia ; Neck ; Osteochondrodysplasias*

OBJECTIVE: To investigate the correlation between the severity of paralysis and hand sympathetic skin response (SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis. METHOD: Twenty patients with Bell's palsy and twenty normal controls were recruited. The severity of paralysis was graded according to House-Brackmann Facial Grading Scale (H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS). RESULTS: The difference of hand SSR amplitude between affected and unaffected side was significant (p<0.05). There was significant correlation between H-B FGS and the difference of hand SSR amplitude (p<0.05). There was significant correlation between percent degeneration and the difference of hand SSR amplitude (p<0.05). There were significant correlations between the difference of hand SSR amplitude at 5 days and percent degeneration at 9 and 14 days (p=0.026, p=0.001). CONCLUSION: The difference of hand SSR amplitude between affected and unaffected side was useful for the indication of the severity of paralysis. And, hand SSR would be useful for an early prognostic predictor in Bell's palsy.
Bell Palsy* ; Facial Nerve ; Hand* ; Humans ; Paralysis ; Prognosis ; Skin*

Enteropathy-type T-cell lymphoma (ETTL) is a rare disease with a poor prognosis. According to the World Health Organization (WHO) classification, it is a subtype of the peripheral T-cell lymphomas. This disease is associated with gluten-sensitive enteropathy, has a high risk of intestinal perforation and obstruction, and is refractory to chemotherapeutic treatment. We report the case of a 73-year-old woman who was diagnosed with enteropathy-type T-cell lymphoma of the small intestine, which was positive for the markers of cytotoxic T cells, CD3, CD8, and CD56, on immunohistochemical staining after resection of the perforated terminal ileum.
Aged ; Celiac Disease/*complications/pathology ; Female ; Gastrointestinal Neoplasms/*complications/pathology ; Humans ; Intestinal Perforation/*diagnosis/*etiology/pathology ; Lymphoma, T-Cell/*complications/pathology

PURPOSE: The relationship between altered HLA expressions and ovarian carcinogenesis is not fully elucidated. MATERIALS AND METHODS: Histological evaluation comprised 20 serous adenocarcinoma, 5 borderline serous malignancy, 10 mucinous adenocarcinoma, 15 borderline mucinous malignancy. We used monoclonal antibodys to HLA class I beta2-microglobulin, class I B/C and class II heavy chain. RESULTS: There was no statistical difference in HLA expressions between borderline serous malignancy and normal ovarian tissue. In serous adenocarcinoma, beta2-microglobulin, B/C and class II heavy chain expressions were down-regulated. In metastatic cancer, B/C and class II ex pressions were also down-regulated. But the HLA expression of tumor or normal stromal tissue in primary tumor, were not down-regulated compared with the tissues in metastasis. In borderline mucinous malignancy, class II expressions were down-regulated. In mucinous adenocarcinoma, beta2-microglobulin, B/C and class II expressions were down-regulated. In metastatic ovarian cancer, B/C and class II expressions were down-regulated. But, in borderline malignancy, the result failed to reach statistical significance except class II of borderline mucinous malignancy. CONCLUSION: Loss of HLA class I and II molecules in invasive ovarian cancers raises the possibility that this could be a mechanism for tumor cells to have invasiveness.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinogenesis ; Mucins ; Neoplasm Metastasis ; Ovarian Neoplasms*

Intestinal duplications are rare developmental abnormalities that may occur anywhere in the gastrointestinal tract. The possibility of a malignant change occurring in these duplications is very low. We present a case of adenocarcinoma arising in a duplication of the cecum. A 41-year-old male patient was admitted because of a palpable abdominal mass. Abdominal computed tomography revealed a 6-cm, peripheral wall-enhanced, round, cystic mass in the cecal area. Excision of the mesenteric mass and a right hemicolectomy was performed. Upon histologic examination, the patient was diagnosed with adenocarcinoma arising in a duplication of the cecum.
Adenocarcinoma/*pathology/radiography/surgery ; Adult ; Biopsy ; Cecal Neoplasms/*pathology/radiography/surgery ; Cecum/*abnormalities/radiography/surgery ; Colectomy ; Humans ; Male ; Tomography, X-Ray Computed ; Treatment Outcome

The present study compares the outcome of adult and pediatric patients with severe diffuse brain injury, and analyzes factors affecting the prognosis related to age difference. Of 912 patients admitted with head injury during the past three years, 223(1.7%) patients were identified as severe diffuse brain injury. Among the 223 patients. 100 patients were 15 years of age or less as the pediatric group. The mortality rate for pediatric and adult group was 39.0% and 48.8%, respectively. The common factors affecting poor prognosis for both groups were Glasgow Coma Scale(GCS) of 5 or less, papillary abnormality, hypoxia(PaO2<60 mmHg), the presence of skull fracture(basilar skull fracture in children, and basilar or vault skull fracture in adult group), diffuse brain swelling, subarachnoid hemorrhage, intraventricular hemorrhage, and thin subdural hematoma. The factors affecting prognostic difference between the adult and pediatric group with diffuse brain injury were the presence of vault skull fracture(p<0.01) and diffuse brain swelling(p<0.05). In patients associated with vault skull fracture or diffuse brain swelling, adult group had a significantly poorer outcome than child group.
Adult ; Brain ; Brain Edema ; Brain Injuries* ; Child ; Coma ; Craniocerebral Trauma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Mortality ; Prognosis ; Skull ; Skull Fractures ; Subarachnoid Hemorrhage

PURPOSE: Operative morbidity and mortality from gastric cancer have decreased in recent years, but many studies have demonstrated that its prevalence is still high. Therefore, we investigated the risk factors for morbidity and mortality considering the type of complication in patients with gastric cancer. MATERIALS AND METHODS: A total of 259 gastrectomies between 2004 and 2008 were retrospectively reviewed. RESULTS: Overall morbidity and mortality rates were 26.6% and 1.9%, respectively. A major risk factor for morbidity was combined resection (especially more than two organs) (P=0.005). The risk factors for major complications in which a re-operation or intervention were required were type of gastrectomy, upper location of lesion, combined resection, and respiratory comorbidity (P=0.042, P=0.002, P=0.031). Mortality was associated with preexisting neurologic disease such as cerebral stroke (P=0.016). In the analysis of different complication's risk factors, a wound complication was not associated with any risk factor, but combined resection was associated with bleeding (P=0.007). Combined resection was an independent risk factor for a major complication, surgical complication, and anastomotic leakage (P=0.01, P=0.003, P=0.011, respectively). Palliative resection was an independent risk factor for major complications and a previous surgery for malignant disease was significantly related to anastomosis site leakage (P=0.033, P=0.007, respectively). CONCLUSIONS: The risk factors for gastrectomy complications of gastric cancer were combined resection, palliative resection, and a previous surgery for a malignant disease. To decrease post-gastrectomy complications, we should make an effort to minimize the range of combined resection, if a palliative gastrectomy is needed for advanced gastric cancer.
Anastomotic Leak ; Comorbidity ; Gastrectomy ; Hemorrhage ; Humans ; Prevalence ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Stroke

Epstein-Barr virus (EBV)-associated disease is known to be one of the major complication after transplantation. Early identification and diagnosis is crucial. The objectives of this study are to evaluate the incidence and to analyze the risk factors of EBV-associated disease. Twenty-five children with liver transplantation from Oct. 1994 to Oct. 1997 had been surveyed. Laboratory data of EBV infection such as anti-viral capsid antigen (VCA) IgM and IgG, EBV PCR, EBV encoded small RNA (EBER) in situ hybridization had been obtained at pre op, and post op 1, 2, 3, 4, 12, 24 weeks, then annually or when EBV infection was suspected. We classified these cases as asymptomatic infection, EBV syndrome, posttransplant lymphoproliferative disease (PTLD). And we analyzed the incidence of EBV infection according to age, type of immunosuppression, and CMV disease. Incidence of EBV infection in this study was 48% (12 out of 25), among them, 5 children were symptomatic and PTLD developed in 2 children. The significant risk factors were age at transplantation and CMV infection. One of PTLD cases resulting from EBV infection showed fatal outcome, the other was improved. We suggested that physicians especially in the care of the children after the liver transplantation should recognize the risk factors of the development of the EBV infection to avoid the progression into the potentially fatal PTLD.
Asymptomatic Infections ; Capsid ; Child ; Diagnosis ; Epstein-Barr Virus Infections ; Fatal Outcome ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunosuppression ; In Situ Hybridization ; Incidence* ; Liver Transplantation* ; Liver* ; Polymerase Chain Reaction ; Risk Factors ; RNA