PURPOSE: To evaluate the application of MRI to the ILAE classification of epilepsies and epileptic syndromes in the setting of epilepsy clinic. METHODS: We reviewed epilepsy registry forms, EEG, and MRI of 300 patients who were consecutively registered to the Yonsei Epilepsy Clinic. The algorhithm of syndromic classification consisted of 3 steps ; 1) clinical diagnosis based on the clinical informations described in the registry form, 2) clinical-EEG correlations, and 3) clinical-EEG-MRI correlations. The interictal epileptiform discharges (IEDs) in EEG were divided into focal, multilobar/multifocal, and generalized. MRI-lesions were divided into focal and non-focal (multilobar/multifocal, and diffuse) lesions. The clinical-EEG, EEG-MRI, and MRI-clinical correlations were categorized as concordant, not discordant, and discordant. RESULTS: Among 300 patients evaluated, 249 patients were found to have epilepsies and both EEG and MRI. By clinical analysis, 190 of 249 patients were diagnosed as localization-related epilepsies (LRE), 24 patients were generalized epilepsies (GE), 34 patients were undetermined epilepsies (UDE), and one patient had alcohol related epilepsy. EEG revealed IEDs in 124 patients and altered the clinical diagnosis in 79 patients. MRI lesions were found in 106 patients with focal lesions in 65 patients and non-focal lesions in 41 patients. MRI lesions were found in 47 of 125 patients with negative EEG. Concordance rates of clinical-EEG, EEG-MRI, and MRI-clinical correlations in 54 patients with lobar epilepsies, who had positive EEG and MRI, were 39%, 54%, and 52%, respectively, and discordant rates were 17%, 11% and 7%, respectively. The complete concordance of all 3 correlations was found in only 33% of them. In 20 patients diagnosed as GE by clinical-EEG correlations, MRI lesions were found in only 3 patients and none of them changed the diagnostic categories due to MRI lesions. CONCLUSION: In lobar epilepsies, the sensitivity of MRI was quite comparable with EEG and the clinical-MRI correlation was superior to the clinical-EEG correlations. MRI provided additional and complimentary informations and should be incorporated to the ILAE-classification system as the category of 'lesional epilepsy'.
Classification ; Diagnosis* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Generalized ; Humans ; Magnetic Resonance Imaging*

OBJECTIVE: To understand the expression pattern of osteopontin on various histologic types of ovarian tumors. METHODS: We performed an immunohistochemical study on 90 paraffin embedded tissues including 80 ovarian epithelial tumors and 10 normal ovaries. We also performed a semiquantitative study of osteopontin mRNA on 12 fresh ovarian tumors, 2 normal ovaries and SKOV3 cell line. SAS 8.2 program was used for statistical analysis and Fisher's Extract test and Cochran-Mantel-Haenszel Statistics for analysis of the relationship between expression of osteopontin and histologic types. RESULTS: Among 55 carcinomas, over 50% of tumor cells expressed osteopontin in 14/14 clear cell, 11/ 12 endometrioid, 11/16 serous, and 5/15 mucinous types. The expression degrees were well correlated with the histologic types of carcinomas (p=0.002). Among 25 benign tumors, over 10% of tumor cells showed in 11/15 serous and 3/10 mucinous types (p=0.008). However, the degree of osteopontin expression was not related to the tumor grades or stages of ovarian cancer. Semiquantitative study for osteopontin mRNA showed 5-6 times higher in SKOV3 cell line as well as in serous adenocarcinomas, compared with the normal ovaries. However, there was no increase of osteopontin mRNA in benign or malignant mucinous tumors. CONCLUSION: Our findings suggest that the expression of osteopontin is not only present in ovarian cancers, but also in benign ovarian tumors.
Adenocarcinoma ; Cell Line ; Female ; Mucins ; Osteopontin* ; Ovarian Neoplasms ; Ovary ; Paraffin ; RNA, Messenger

Once ingested foreign bodies pass through the stomach, 80 to 90 percent of them will exit via the gastrointestinal tract and they are excreted naturally in 7-10 days; surgical treatment is not required in most case. But once foreign bodies permeate the appendix, it is difficult for them to be excreted again to the cecum; therefore, this can possibly cause appendicitis or perforation. Especially in case of long, pointed, thin, stiff, sharp and/or metalic objects, the risk of perforation will increase. We attempted to remove an endodontic file in the appendix by colonoscopy. This was done in a patient who came to hospital because he swallowed an endodontic file during endodontic therapy. But we failed to retrieve it, and so we got rid of the foreign body by performing elective surgery before the occurrence of complications. We report here on surgical removal of an apppendiceal foreign body along with a review of the literature.
Appendicitis ; Appendix* ; Cecum ; Colonoscopy ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Stomach

BACKGROUND: Since 2001, the Ministry of Health and Welfare in Korea has designated muscular dystrophy (MD) to be a rare and intractable disease, and has ensured that patients with this condition obtain support from the National Health Insurance Corporation for their medical expenditure. However, the health-related and socioeconomic status of Korean patients with MD has yet to be established. METHODS: We selected 441 patients with MD who received medical services at 17 neuromuscular centers during 2005. The medical records of selected patients were analyzed, and the subtype of MD was classified by its clinical course and diagnostic tests. A total of 95 patients or their family members participated in this health-related and socioeconomic status survey. RESULTS: Medical record analysis showed similar clinical and diagnostic characteristic data to those published previously in other countries: male predominance, being young at onset, and muscular weakness of the extremities as a predominant symptom in most patients. The diagnostic tests for MD were based on laboratory and electrophysiological studies. The most frequent form of MD among our cohort was Duchenne/Becker muscular dystrophy (42%). Our survey revealed the effect of the patients' profound disability on their activities of daily living. One-half of the patients were dissatisfied with the medical expenditure support service that was made available to them, and most patients suffered from a financial burden. The most important medical services to be developed in the future are expansion of the public health service or development of a rehabilitation hospital. CONCLUSIONS: This is the first multicenter-based epidemiologic study on the health-related and socioeconomic status of patients with MD in Korea. The findings indicate that medical coverage and public health service are currently inadequate and hence should be expanded in the future.
Activities of Daily Living ; Cohort Studies ; Diagnostic Tests, Routine ; Epidemiologic Studies ; Extremities ; Health Expenditures ; Humans ; Korea ; Male ; Medical Records ; Morphinans ; Muscle Weakness ; Muscular Dystrophies ; National Health Programs ; Social Class ; United States Public Health Service

PURPOSE: In Korea, pregnancy termination is frequently reported among women who took medications for an acute or chronic disease during pregnancy, for fear of teratogenic risk. We have previously shown that a service providing evidence-based information is helpful for women who week counseling to make a rational decision regarding their pregnancies. This study aimed to evaluate whether termination of pregnancy based on such perceptions, is justified using the 'DRug Exposure and risk Assessment in Moms' (DREAM) registry. METHODS: The study included 5,032 consenting pregnant women from the clinic and call center at the Korean Motherisk Program, from November 1999 to October 2008. The DREAM registry recorded the pregnancy outcomes (preterm birth, low birth weight, intrauterine fetal death, and congenital anomaly) of 3,328 women. RESULTS: Among women exposed to medications, time of exposure ranged from 3.5-4.6 weeks of gestation. There were 1,308 different drugs prescribed to these women. The drug most frequently prescribed was acetaminophen followed by chlorpheniramine maleate, and pseudoephedrine. There were 4.7% (n=156/3,328) women who underwent a voluntary abortion for fear of birth defects. We compared frequency of birth defects between exposed women and unexposed pregnant women in our institution during gestation. The frequency of major congenital malformations was 2.5% (n=74/2,977) in exposed group and 2.9% (n=75/2,573) in unexposed group (P=0.32). There was no statistically significant difference between exposed and control group in the rate of preterm births, intrauterine fetal death and low-birth weight babies. CONCLUSION: We did not observe increased risk of congenital malformations and adverse pregnancy outcomes in a population of pregnant women exposed to a variety of medications. Therefore these medications are not considered teratogen.
Acetaminophen ; Chlorpheniramine ; Chronic Disease ; Congenital Abnormalities ; Counseling ; Female ; Fetal Death ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Maleates ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Premature Birth ; Pseudoephedrine ; Risk Assessment