Objective: To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. Methods: Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. Results: There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. Conclusion Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

OBJECTIVES: The purpose of this study was to make empirical evidence for a community based case management program for the first episode of psychosis. METHODS: We provided a case management program for first episode psychosis patients and assessed their symptoms, function, insight, and satisfaction using Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), Scale to assess Unawareness of Mental Disorder (SUMD), Global Assessment of Functioning Scales (GAF), and Quality of Life scales (QOL) at baseline and after the program. We also evaluated the treatment maintenance rate and the changes of their developmental task achievement. RESULTS: Significant improvement was observed in all sub-domains of PANSS and significant changes were also observed in the areas of symptoms and function of HoNOS. Significant improvement was observed in awareness of mental illness itself and its outcomes. The treatment maintenance rate was 87.5%, including three patients who stopped their medication with the doctor's order. The rate of participation in meaningful social activities, such as school or job showed an increase, from 25% at baseline to 81% after the program. CONCLUSION: Results of this study demonstrate the possibility of community programs for prevention of relapse, improvement of symptoms and function, and facilitation of return to meaningful social activities of first episode psychosis patients.
Case Management ; Humans ; Mental Disorders ; Psychotic Disorders ; Quality of Life ; Recurrence ; Weights and Measures

We present herein an unusual case of multilocular thymic cyst, with prominent lymphoid follicular hyperplasia, in a 64-year-old man. It was incidentally founded as a mediastinal mass on chest radiography, during a routine health check-up. Computed tomography revealed a cystic lesion, which contains thick septa involving the thymus. The resected mass, 8x4 cm in diameter, involved the thymus and there is no adhesion or invasion into the adjacent tissue. The cut surface showed cystic spaces with thick white-tan firm wall, which cysts contained gelatinous material. Microscopically, the lesion was characterized by multiple cysts, lined by flattened cuboidal epithelium that was separated by thick walls, having a dense lymphoid tissue with lymphoid follicles. The patient was discharged without any complication and is well without evidence of recurrence for sixteen months.
Epithelium ; Gelatin ; Humans ; Hyperplasia ; Lymphoid Tissue ; Mediastinal Cyst ; Mediastinal Diseases ; Middle Aged ; Recurrence ; Thorax ; Thymus Gland

Autoimmune thyroid disease associated with Moyamoya syndrome has mostly been reported as Graves' disease, and not as Hashimoto's thyroiditis. We report a case of a 70-year-old man with right posterior cerebral artery territorial infarction and bilateral distal internal carotid artery occlusion, which suggests Moyamoya syndrome, but who was diagnosed as Hashimoto's thyroiditis.
Aged ; Carotid Artery, Internal ; Graves Disease ; Humans ; Infarction ; Moyamoya Disease ; Posterior Cerebral Artery ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis

Ovarin hyperstimulation syndrome (OHSS), an iatrogenic complication of ovarian stimulation, shows varying degrees of clinical manifestations. The pathogenesis of OHSS is an increase of vascular permeability resulting in hypovolemia, thromboembolism, ARDS, and death in sometimes. Pleural effusion is also a result of an increase of vascular permedability in the pleura. Thoracentesis is sometimes required to relieve dyspnea. We report a case of OHSS with bilateral exudative pleural effusfion is a 23 year-old female with resting dyspnea. She was received clomi;hen, FSH, and LH for the treatment of irregular menstruation twenty days previously. The ultrasonogram showed severe ascites and bilaterally huge ovary, and chest radiography showed bilateral effusion. Therapeutic thoracentesis and paracentesis were done for relief of the dyspnea. Two weeks later the bilateral effusion and symptoms disappeared spontaneously.
Ascites ; Capillary Permeability ; Dyspnea ; Exudates and Transudates ; Female ; Humans ; Hypovolemia ; Menstruation ; Ovarian Hyperstimulation Syndrome* ; Ovary ; Ovulation Induction ; Paracentesis ; Pleura ; Pleural Effusion* ; Radiography ; Thorax ; Thromboembolism ; Ultrasonography

Diabetes and impaired fasting glucose are associated with incidence of cerebro-/cardio-vascular diseases. This study hypothesized that fasting glycemic status may reflect cerebrovascular risk in non-diabetic Koreans. Fasting glycemic status, lipid profiles, oxidative stress, and inflammation markers were measured in non-diabetic subjects (healthy controls, n = 112 and stroke n = 41). Systolic blood pressure, fasting glucose, glycated hemoglobin (HbA1C), triglycerides, high sensitivity C-reactive protein (hs-CPR), interleukin-6, and tumor necrosis factor-alpha were higher, and high density lipoprotein (HDL)-cholesterols were lower in patients with stroke than healthy controls. Fasting glucose positively correlated with hs-CRP, interleukin-6, tumor necrosis factor-alpha, oxidized low density lipoprotein (LDL) and malondialdehyde. The significances continued or at least turned to a trend after adjustments for confounding factors. Multiple regression analyses revealed that fasting glucose was mainly associated with cerebrovascular risk (beta'-coefficient = 0.284, p < 0.0001) together with age, systolic blood pressure, total cholesterol, hs-CRP, body mass index, dietary poly unsaturated fatty acid/saturated fatty acid (PUFA/SFA), and HbA1C (r2 = 0.634, p = 0.044). The subjects were subdivided by their fasting glucose levels [normal fasting glucose: 70-99 mg/dL, n = 91 [NFG-control] and n = 27 [NFG-stroke]; higher fasting glucose: 100-125 mg/dL, n = 21 [HFG-control] and n = 14 [HFG-stroke]). In both controls and stroke patients, HFG groups show higher triglyceride, total- and LDL-cholesterol and lower HDL-cholesterol than NFG groups. Control-HFG group showed significantly higher levels of oxidative stress and inflammation than control-NFG group. Stroke-HFG group also showed significantly higher inflammatory levels than stroke-NFG group, moreover the highest among the groups. Additionally, stroke-NFG group consumed higher PUFA/SFA than stroke-HFG group. Fasting glucose may be a useful indicator for cerebrovascular risk in non-diabetic individuals which may be mediated by oxidative stress and inflammation status.
Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Cholesterol ; Fasting* ; Glucose* ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Inflammation* ; Interleukin-6 ; Lipoproteins ; Malondialdehyde ; Oxidative Stress* ; Stroke ; Triglycerides ; Tumor Necrosis Factor-alpha

This study aimed to investigate if glycated hemoglobin (HgbA1C) as compared to fasting blood glucose is better for reflecting cardiometabolic risk in non-diabetic Korean women. Fasting glucose, HgbA1C and lipid profiles were measured in non-diabetic women without disease (n = 91). The relationships of fasting glucose or HgbA1C with anthropometric parameters, lipid profiles, and liver and kidney functions were analyzed. Both fasting glucose and HgbA1C were negatively correlated with HDL-cholesterol (r = -0.287, p = 0.006; r = -0.261, p = 0.012), and positively correlated with age (r = 0.202, p = 0.008; r = 0.221, p = 0.035), waist circumference (r = 0.296, p = 0.005; r = 0.304, p = 0.004), diastolic blood pressure (DBP) (r = 0.206, p = 0.050; r = 0.225, p = 0.032), aspartate transaminase (AST) (r = 0.237, p = 0.024; r = 0.368, p < 0.0001), alanine transaminase (ALT) (r = 0.296, p = 0.004; r = 0.356, p = 0.001), lipid profiles including triglyceride (r = 0.372, p < 0.001; r = 0.208, p = 0.008), LDL-cholesterol (r = 0.315, p = 0.002; r = 0.373, p < 0.0001) and total cholesterol (r = 0.310, p = 0.003; r = 0.284, p = 0.006). When adjusted for age and body mass index, significant relationships of DBP (r = 0.190, p = 0.049), AST (r = 0.262, p = 0.018), ALT (r = 0.277, p = 0.012), and HDL-cholesterol (r = -0.202, p = 0.049) with HgbA1C were still retained, but those with fasting glucose disappeared. In addition, the adjusted relationships of LDL-cholesterol and total cholesterol with HgbA1C were much greater than those with fasting glucose. These results suggest that glycated hemoglobin may be a better predictor than fasting glucose for cardiometabolic risk in non-diabetic Korean women.
Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Fasting* ; Female ; Glucose* ; Hemoglobin A, Glycosylated* ; Humans ; Kidney ; Liver ; Triglycerides ; Waist Circumference

BACKGROUND: We studied about the The different features of high-resolution CT (HRCT) findings of active pulmonary tuberculosis(TB) were studied between acid fast bacilli(AFB) smear or culture positive and negative group. METHODS: We prospectively evaluated 36 patients who had been confirmed for active pulmonary tuberculosis by the smear or culture of AFB in sputum(n=25), and changes on serial chest radiographs(n=11). The patient were divided into 3 groups by the results on sputum AFB stain and culture. Group 1(n=11) is negative in both AFB stain and culture ; group 2(n=13) is negative in AFB stain but positive in culture ; and group 3(n=12)is positive in both AFB stain and culture. We evaluated the findings of HRCT in each group randomly. RESULT: On the HRCT scans, acinar nodule(100%), macronodule(75%), and cavity(75%) in group 3 were more frequently found than group 1(63%, 18%, 9%) and group 2(46%, 15%, 23%)(p<0.05). The centrilobular nodule and branching structure in group 3(92%) was more frequently observed were more frequently observed in group 3 (92%) than in group 1(54%)(p<0.05), but not different than were similarly observed in group 2(77%)(p>0.05). AFB positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(100% vs 54%), macronodule(75% vs 17%), and cavity(75% vs 17%)(p<0.05). TB culture positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(72% vs 45%) and cavity(48% vs 9%)(p<0.05). CONCLUSIONS: HRCT scans are helpful in determining disease acitivity in sputum AFB stain- negative pulmonary tuberculosis. When HRCT shows centrilobular nodule and branching structure, acinar nodule, macronodule, cavity, we are able to decide more study such further studies as sputum induction and bronchoscopy for determination of can be performed to determine the presence of bacilli in patients of AFB stain-negative tuberculosis.
Bronchoscopy ; Humans ; Prospective Studies ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Angiomyofibroblastoma (AMFB) is an uncommon benign mesenchymal tumor. AMFB occurs almost in the vulvo-vaginal area of women. The gross features of AMFB are well-circumscribed so it clinically is often thought as Bartholin gland cyst or aggressive angiomyxoma. Usually, most tumors grow slowly, and patients do not feel pain. It also has low tendency for local recurrence. The histologic findings of the tumors are abundant thin-walled blood vessels with hypocellular and hypercellular areas. Almost all tumor cells have immunoreactivity for both desmin and vimentin. It also has estrogen and/or progesterone receptors, but staining for cytokeratin is negative. Here is a case of AMFB of the vulva occurring in a 40-year-old woman, involving the right labia majora. The patient described that her vulva mass grew in about few months. The maximum dimension of the tumor was measured as 2 cm, and we resected the tumor one month after as her second visit.
Adult ; Blood Vessels ; Cinnarizine ; Desmin ; Estrogens ; Female ; Humans ; Keratins ; Myxoma ; Receptors, Progesterone ; Recurrence ; Vimentin ; Vulva

A 74-year-old woman complained of dysphagia and hemoptysis after ingesting a fragment of crab shell while eating crab salted-fermented fish products, and presented dyspnea that had lasted for three days. Computed tomography indicated pneumomediastinum. Laboratory results revealed acute renal failure. The patient experienced respiratory distress and shock over the days following her initial presentation. Upper gastrointestinal endoscopy revealed black pigmentation of the esophageal mucosa from the middle to lower esophagus. Despite intensive care, the patient's condition deteriorated and she died. This is the first case of acute esophageal necrosis associated with esophageal foreign body injury and the development of pneumomediastinum reported in Korea.
Acute Kidney Injury ; Aged ; Deglutition Disorders ; Dyspnea ; Eating ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophagus ; Female ; Fish Products ; Foreign Bodies ; Hemoptysis ; Humans ; Critical Care ; Korea ; Mediastinal Emphysema ; Mucous Membrane ; Necrosis ; Pigmentation ; Shock