Vascular dementia is defined as a clinical syndrome of acquired intellectual impairment resulting from a brain injury due to a cerebrovascular disorder. It incorporates various vascular pathophysiological mechanisms and changes in the brain, and has diverse cause and clinical manifestations. The main suptypes of vascular dementia include 1) multi-infarct dementia, 2) strategic infarct dementia, and 3) subcortical vascular dementia. Both multi-infarct dementia and strategic infarct dementia show heterogeneity in etiologies, changes of the brain, as well as clinical manifestations. On the contrary, subcortical vascular dementia is suggested to be a more homogenous group. To better understand the clinical features of vascular dementia, cases corresponding to each subtype of vascular dementia are briefly discussed this review.
Brain ; Brain Injuries ; Cerebrovascular Disorders ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Population Characteristics

Stroke is one of the leading causes of death in Korea. According to the report from Korean national statistical office, the mortality rate of stroke was 73.2/100,000 persons in 2000. In Western countries, stroke mortality rates declined gradually from 1970, which accelerated markedly around 1990. Since then, there has been no further decrease in stroke mortality rates until now and the situation has been similar in Korea. In the past, hemorrhagic stroke in Korea similar to other Far East Asian countries. However, the ratio of hemorrhagic to ischemic stroke has been reversed since mid-1980s. This trend might be due to the westernization of diet and life style as well as better control of hypertension. The case fatality rate from one of the large hospital-based stroke registry was 7.2% within 30 days after the onset of acute ischemic stroke, which is similar to those of other series from western countries with an advanced medical care systems. It may be attributed to the inclusion of more asymptomatic or milder patients with small lesions detected by neuroimaging. Importantly, the delay of hospital visit after the onset of stroke and the lower compliance for secondary prevention remain serious problems in managing acute stroke in Korea. Despite recent advances in the diagnosis and management of stroke, there has not been a nationwide population-based epidemiologic data on stroke in Korea. Therefore the application of Internet technology to develop multi center cooperative hospital-based registry could be an important step toward a long-waited nationwide stroke registry.
Asian Continental Ancestry Group ; Cause of Death ; Compliance ; Diagnosis ; Diet ; Epidemiology* ; Far East ; Humans ; Hypertension ; Internet ; Korea* ; Life Style ; Mortality ; Neuroimaging ; Secondary Prevention ; Stroke*

Gastric mucosa shows continuous changes in surface epithelium as well as inflammatory reaction by various substances from the outside and their metabolic products. Gastric mucosal lesions are proven to be associated with bacterial infection by the discovery of Heliobacter pylori(H. pylori) and many studies about histopathologic changes of gastric mucosa associated H. pylori infection has been advanced. It is known that H. pylori associated gastritis displays surface foveolar epithelial changes, such as cytoplasmic vacuolation, mucin loss, juxtaluminal cytoplasm erosion, epithelial denudation, and mucosal irregularity. There have been many studies that H. pylori infection is associated with intestinal metaplasia, gastric dysplasia, and carcinoma. Also chronic H. pylori infection with its induction of gastric lymphoid follicle has been implicated as a precursor of gastric lymphoma of the unique B-cell type that arises from mucosa-associated lymphoid tissue(MALT). However, these gastric mucosal changes are also observed in gastritis with other causes. In this study, we aimed to define specific histopathiologic findings associated with H. pylori infection. A total of 463 gastric biopsy specimens were reviewed. They were Helicobacter-associated gastritis and were divided as many (MH), a few (AH), and no (NH), according to the number of H. pylori. 210 (MH), 131 (AH), and 122 (NH) biopsy specimens were included. Lymphocytes, plasma cells in lamina propria, eosinophils and neutrophils in surface epithelium and crypt as well as lamina propria were graded from 0 to 3. Surface epithelial changes including cytoplasmic vacuolation, mucin loss, juxtaluminal erosion, epithelial denudation and mucosal irregrarity were observed in 200 of 210 cases(95%) in MH group, 34 of 131 cases(26%) in AH group, and 6 of 122 cases(5%) in NH group. This result indicates there is significant difference in surface epithelial changes according to the number of H. pylori(p<0.001). Severity of eosinophil, neutrophil, lymphocyte, and plasma cell infiltration is increased in proportion to the number of H. pylori. Especially, neutrophilic infiltration is not identified in 95 of 122 cases(78%) in NH group, whereas MH group shows severe infitration (grade 3) in 127 of 210 cases(61%), and no (grade 0) in 11 of 210 cases(5%). This data well explains that the severity of neutrophil infiltration is associated with, the degree of H. pylori infection in chronic active gastritis, with statistical significance. The prevalence of lymphoid follicle formation was 17 of 120 cases(14%) in NH group, 24 of 131 cases(18%) in AH group, and 52 of 210 cases(25%) in MH group. This shows that lymphoid follicle formation correlates with the number of H. pylori, but without statistical significance. The prevalence of intestinal metaplasia in NH, AH, and MH was 43 of 122 cases(35%), 46 of 131 cases(35%), and 69 of 210 cases(33%), showing no association between intestinal metaplasia and H. pylori. In summary, H. pylori associated gastritis dispays characteristic histopathological changes in gastric mucosa, in which surface epithelial changes and various inflammatory infiltrates are increased in proportion to the number of H. pylori. Especially vacuolization of surface foveolar epithelium, cryptitis, and crypt abscess are specific findings of H. pylori associated gastritis.
Biopsy

OBJECTIVE: Closure of a low transverse cesarean incision with one layer and two layer, we compared operative time, hemostasis, blood loss and postoperative sonohysteroperitoneographic findings. Study design: At our hospital 103 women were randomized to closure of a low transverse cesarean incision with either one continuous layer of a locking No. 1 chromic suture or two continuous of No. 1 chromic suture with the first layer locked between Mar. 1, 1998 and Dec. 31, 1998. After three months later, sonhysteroperitoneography was taken and then we evaluated uterus indirectly. RESULTS: A one layer closure required less operative time, 16 versus 20.8 minutes (p<0.01), less hemoglobin change, 0.44 versus 1.3 (p<0.01) and less suture materials (p<0.01). But postoperative follow up sonohysteroperitoneography, a one layer closure shows slightly thinning of isthmic layer of myometrium, two layer closure shows more adhesional band and both are similar other findings. CONCLUSION: A one layer does not significantly affect the clinical course than traditional two layer closure. So we recommended a one layer closure when its use is anatomically feasible.
Animals ; Female ; Follow-Up Studies ; Hemostasis ; Humans ; Mice ; Myometrium ; Operative Time ; Sutures ; Uterus

Crypt glandular infection theory is accepted as an explanation of anal fistula's major cause. However, the pathogenesis of an anal fistula in Crohn's disease is different from that of a conventional anal fistula because a Crohn's anal fistula is caused by ulceration which, in turn, is caused by transmural inflammation of the rectal wall due to Crohn's disease. The difficulty with operating on anal fistulas in Crohn's disease lies in the fact that healing of the wound is inhibited because of continuous inflammation of the anorectal tissue due to Crohn's disease. Hence, there is a high possibility of incontinence due to sphincter muscle injury. Especially, because almost all Crohn's disease patients have frequent defecation and diarrhea, the patients will suffer more if incontinence occurs. Nowadays, even with increased understanding of the etiology of Crohn's disease, new medications, and aggressive surgical approaches, the result of treatment is still not satisfactory. Recently, since Korean eating habits have changed to include more western-style food in the diet, inflammatory bowel disease, such as Crohn's disease, is expected to increase. Consequently, the number of cases of anal fistulas in Crohn's disease is also expected to increase. The authors reviewed 20 confirmed cases of anal fistulas in Crohn's disease, which were treated from January 1993 to December 1995 at Song-Do Colorectal Hospital. The results are as follows: 1) Anal fistulas in Crohn's disease were present in 20(0.6%) of the 3378 cases of anal fistulas treated during the time period considered. 2) The male to female ratio for these 20 cases was 2: 1, and the most Prevalent age group was the 3rd decade, followed by the 2nd decade, the 4th decade, and the 5th decade in that order. 3) Three cases of anal fistulas whose origins could be explained by crypt glandular infection theory and which did not involve the rectum healed, although the healing was delayed. 4) Seventeen cases of anal fistulas whose origins could not be explained by crypt glandular infection theory and which involved the rectum did not heal after the operation. he results of the study show that anal fistulas whose origins can be explanined by crypt glandular infection theory and which do not involve the rectum can be cured by conventional fistula surgery. However, perirectal fistulas whose origins can not be explained by crypt glandular infection theory and which involve the rectum do not heal. Because there is the possibility of incontinence after a conventional operation, it is suggested that, in the cases of perirectal fistulas in Crohn's disease, better results, although not completely satisfactory, can be obtained by long-term seton drainage and diversion colostomy.
Colostomy ; Crohn Disease* ; Defecation ; Diarrhea ; Diet ; Drainage ; Eating ; Female ; Fistula ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Male ; Rectal Fistula* ; Rectum ; Ulcer ; Wounds and Injuries

PURPOSE: To evaluate the findings and the role of CT in plexiform neuro-fibromatosis of the mediastinum. MATERIALS AND METHODS: We retropectively reviewed the CT scans of five patients with plexiform neurofibromatosis of the mediastinum. The CT scans were reviewed with attention to the distribution of the lesions, appearance and attenuation of mediastinal lesions, enhancement pattern after intravenous contrast infusion and associated findingssuch as intercostal neurofibroma. RESULTS: In all five patients CT scans demonstrated fusiform low attenuated masses which were oriented longitudinally and extended over multiple contiguous scans along the distribution of major mediastinal nerves. In four patients, mediastinal lesions appeared infiltrative, obliterating adjacent mediastinal fat plane. One patient had well defined fusiform masses along the major mediastinal nerves. Postcontrast enhanced CT scans revealed slight central enhancement in two patient and no contrast enhancement in three patients. Associated findings such as neurofibromas of intercostal nerves and sympathetic trunk, or subcutaneous neurofibromas were detected on CTscans in all five patients. CONCLUSION: Characteristic CT findings of low attenuation masses along the major mediastinal nerves are helpful to differentiate plexiform neurofibromatosis from mediastinal lymphadenopathy and to prevent from misreading as a malignant disease.
Humans ; Intercostal Nerves ; Lymphatic Diseases ; Mediastinum* ; Neurofibroma ; Neurofibromatoses* ; Tomography, X-Ray Computed

Transient global amnesia(TGA) is not a rare event in the elderly, which is characterized by transient inability to form the new memory traces plus retrograde amnesia with benign prognosis. The etiology is unknown, but suggested causes have included transient ischemic attack, migraine, epilepsy, brain tumor, drug intoxication, other toxic/metabolic disturbances, or hysteria. Especially, TGA associated with ischemic stroke is important on the elderly patients and necessary to be differentiated with other causes, for stroke prevention. As far as we know, the case of TGA due to cerebral infarction confirmed by brain imaging study is extremely rare in the literature. We report the case of 67 year-old female patient with typical TGA showing ischemic lesion on the right temporal area on MRI and discussed its significance as one of the cause of TGA.
Aged ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Brain Neoplasms ; Cerebral Infarction ; Epilepsy ; Female ; Humans ; Hysteria ; Infarction* ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Memory ; Migraine Disorders ; Neuroimaging ; Prognosis ; Stroke

Acute infarcts of the anterior inferior cerebellar artery (AICA) territory are unusual. Furthermore incomplete AICA infarcts are perplexing because of its variations of vascular anatomy and inconsistent clinical features. We present a case with clinical features of AICA infarction, which consist of ipsilateral peripheral-type facial palsy, vertigo, and contralateral facial and upper limb sensory changes without motor weakness. The patient had hypertension and was a current smoker. The high signal intensity on inferior pontine tegmental area was found on MRI and the R2 interneuronal dysfunction was note on Blink reflex. The angiographic findings didn't show any focal vascular lesions, which is contrary to the pathogenesis of AICA infarction published previously. On the clinical ground, the present case reserves to attention in that patients with peripheral-type facial palsy should be properly evaluated and with thorough neurological examination and we could differentiate between the incomplete AICA infarcts such as Gasperini syndrome and Bell's palsy.
Arteries ; Bell Palsy ; Blinking ; Facial Paralysis* ; Humans ; Hypertension ; Infarction ; Interneurons ; Magnetic Resonance Imaging ; Neurologic Examination ; Upper Extremity ; Vertigo

PURPOSE: Prostate volume has been poorly correlated with various parameters used to assess benign prostate hyperplasia (BPH), including symptom score, total prostate volume, peak flow rate and postvoid residual urine. The purpose of this study is to determine if measurement of the volume and the index of transition zone of the prostate correlated well with other clinical parameters in predicting the degree of obstruction. MATERIALS AND METHODS: 121 men with lower urinary tract symptoms were prospectively evaluated using international prostate symptom score, transrectal ultrasonography, and urodynamic investigation with pressure-flow studies for BPH. Bladder outlet obstruction was defined as the maximal detrusor pressure was greater than 40cmH2O at peak flow and peak flow rate was less than 10ml/sec. Patients were then divided into obstructive and non-obstructive groups. Correlations were evaluated among the total prostatic volume (TPV), transition zone volume (TZV), transition zone index (TZI=TZV/TPV) and other clinical and urodynamically obstructive parameters. RESULTS: Age, IPSS, peak flow rate and PVR were not significantly different between obstructive (n=69) and non-obstructive (n=52) groups. Among the transrectal sonographic parameters, TZV and TZI correlated better with urodynamically obstructive parameters such as detrusor pressure at peak flow rate (r=0.551, 0.544), Abrams Griffiths number (r=0.576, 0.506) and linear passive urethral resistance relation (r=0.560, 0.580) than with TPV. There were no correlations between clinical and volume parameters. All the volume parameters of the prostate were larger in obstructive than in non- obstructive group. CONCLUSIONS: In patients with BPH symptoms, TZV and TZI correlates better with urodynamically obstructive parameters than did the total prostate volume. TZV or TZI may serve as more useful method for evaluating obstruction.
Humans ; Hyperplasia* ; Lower Urinary Tract Symptoms ; Male ; Prospective Studies ; Prostate* ; Prostatic Hyperplasia ; Ultrasonography ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urodynamics

We report a case of Becker's nevus associated with smooth muscle hamartoma, in a 21-year-old male patient, which shows clinically match-head sized, flat topped, round to oval, grouped papules with hairs on the outer surface of the right arm, and microscopically reveals numerous bundles of smooth muscle fiber in the dermis.
Arm ; Dermis ; Hair ; Hamartoma* ; Humans ; Male ; Muscle, Smooth* ; Nevus* ; Young Adult