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*

PURPOSE: To compare autonomic dysfunction in patients with urge urinary incontinence(UUI), patients with stress urinary incontinence(SUI) and normal group, we measured and analyzed heart rate variability to compare among the three groups. MATERIALS AND METHODS: We studied heart rate variability(HRV) in 30 patients with UUI(mean age, 47.7+/-10.0 years old), 40 patients with SUI(mean age, 47.6+/-8.7 years old), 120 healthy controls(mean age 45.2+/-6.9 years old). The parameters of HRV of the three groups were compared. RESULTS: There was no difference in uroflowmetry and heart rate among the three groups. In time domain, square root of the mean squared difference of successive N-N interval(RMSSD) in UUI was higher than that of the others, and standard deviation of N-N interval(SDNN) showed no difference. In frequency domain, low frequency(LF) in UUI, an indicator of cardiac sympathetic tone, was higher than thar of the others. Very low frequency(VLF), LF, low-frequency/high-frequency ratio(LF/HF ratio) didn't show difference. CONCLUSION: All parameters of HRV analysis in UUI were not same as those of SUI and controls. The increase in RMSSD and HF means that there could be imbalance in autonomic nervous system and it could be the cause of detrusor overactivity in UUI.
Autonomic Nervous System ; Heart Rate ; Humans ; Pilot Projects* ; Urinary Incontinence*

Intracavernous self-injection of vasoactive agents for erectile dysfunction has been widely used in recent years due to its effectiveness and low rate of complications. Intracorporeal needle breakage during intracavernous self-injection represents an unusual complication. We report a case of intracorporeal needle breakage during self-injection of prostaglandin E1 in a 61-year-old man.
Alprostadil ; Erectile Dysfunction ; Humans ; Male ; Middle Aged ; Needles*

Lateralized tympanic membrane is a complication of tympanoplasty resulting in conductive hearing loss. We describe a case of a 23-year-old patient who developed totally lateralized left tympanic membrane with hearing disturbance. The blind-pouch appearance of the left ear canal and conductive hearing loss were checked. The revision of underling tympanoplasty was performed using temporalis fascia and conchal cartilage. The ossicular chain was reconstructed with partial ossicular replacement prosthesis. Canaloplasty and split thickness skin graft were applied for the skin defect of the left external auditory meatus. Totally lateralized tympanic membrane was successfully reconstructed with cartilage tympanoplasty and canaloplasty, achieving improved hearing.
Cartilage ; Ear Canal ; Fascia ; Hearing ; Hearing Loss, Conductive ; Humans ; Ossicular Prosthesis ; Postoperative Complications ; Skin ; Skin Transplantation ; Transplants ; Tympanic Membrane ; Tympanoplasty

BACKGROUND/AIMS: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. MATERIALS AND METHODS: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. RESULTS: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. CONCLUSIONS: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.
Body Mass Index ; Classification ; Diabetes Mellitus ; Diagnosis ; Dyslipidemias ; Endoscopy* ; Esophagitis ; Esophagitis, Peptic* ; Follow-Up Studies* ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hypertension ; Korea* ; Natural History ; Nephrosis, Lipoid ; Proton Pump Inhibitors ; Smoke ; Smoking ; Waist Circumference

Gangliogliomas are rare benign tumors of the central nervous system consisting of neoplastic ganglion and low grade glial cells. The purpose of our investigation was to evaluate the clinical, radiological, surgical, and pathological features and outcome of ten patients with intracranial ganglioglioma who underwent surgery between June 1989 and December 1996. The mean follow-up period was about 24 months(range, 6-66 months) after their initial operation. The series consisted of six males and four females, and their mean age was 29.7 years. The mean length of symptoms was 9.1 years. Seizure was the most common presenting symptom and occurred in eight of ten patients. MRI findings were variable, and showed no characteristic patterns. The temporal lobe was the most common site of involvement(6/10). During surgery, a sharp demarcation between tumor and normal brain tissue was seen in seven of ten cases. Five of ten cases were solid, and the remaining cases were cystic in two, cystic with mural nodule in two, and soft, suckable in one. Total resection was possible in seven of ten patients. Diagnosis was established by identifying a mixture of abnormal astrocytic and neuronal components. Two patients showed astrocytic predominance; four, a neuronal predominance; and four, an equal admixture of cell types. All cases were benign. Other histopathological findings included microcystic change, desmoplasia, eosinophilic granular body, microcalcification, and lymphocytic infiltration. At the time of writing, all seven patients who underwent total resection were alive without recurrence; of the three who underwent subtotal resection, two were alive and in a stable condition, while in the other, the tumor had progressed within 12 months of surgery and adjuvant radiation therapy had thus been required. The patients was, though, still alive. In seven of eight patients, the frequency of seizure had markedly decreased. Our study confirms that this tumor is a distinct clinical and histological entity with a predilection for the temporal lobe. Although the number of patients and follow-up period are limited, this study also shows that epilepsy is extremely well controlled and that survival after surgical resection is good.
Brain ; Central Nervous System ; Diagnosis ; Eosinophils ; Epilepsy ; Female ; Follow-Up Studies ; Ganglioglioma* ; Ganglion Cysts ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroglia ; Neurons ; Recurrence ; Seizures ; Temporal Lobe ; Writing

BACKGROUND: To characterize the ictal electrocorticographic features in relation to surgical outcome in nonlesional neocortical epilepsy (NE). METHODS: Seventeen patients with intractable NE underwent surgeries after chronic subdural recordings. All patients did not have any lesions on brain MRI, which was confirmed by pathology postoperatively. One hundred and eighty one ictal EEGs recorded from subdural electrodes were analyzed. Surgical outcome was determined by seizure reduction rate, and free or more than 75% reduction was defined as favorable outcome. The mean duration of follow-up was 55+/-8.7 months. RESULTS: Reproducible ictal onset zone (IOZ) in more than a half of seizures (p=0.002), and persistent ictal discharges in IOZ from the onset to the end of seizure were found more frequently in the patients with good outcome (p=0.004). Ictal onset patterns consisting of low voltage fast or high amplitude beta spikes predicted a good surgical outcome while rhythmic sinusoidal activity or rhythmic spike/sharp wave were predictive of poor outcome (p=0.01). The ictal onset rhythm consisted of gamma or beta frequencies was more prevalent in the favorable group (p=0.003). CONCLUSIONS: The presence of stable ictal circuit suggested by the consistent earliest activation in more than 50% of seizures and the active participation of IOZ throughout the attack were valuable prognostic factors in addition to the morphology and frequency of ictal onset rhythm.
Brain ; Electrodes ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pathology ; Prognosis ; Seizures

PURPOSE: The objective of this study was to investigate the relationships between primary implant stability as measured by impact response frequency and the structural parameters of trabecular bone using cone-beam computed tomography(CBCT), excluding the effect of cortical bone thickness. METHODS: We measured the impact response of a dental implant placed into swine bone specimens composed of only trabecular bone without the cortical bone layer using an inductive sensor. The peak frequency of the impact response spectrum was determined as an implant stability criterion (SPF). The 3D microstructural parameters were calculated from CT images of the bone specimens obtained using both micro-CT and CBCT. RESULTS: SPF had significant positive correlations with trabecular bone structural parameters (BV/TV, BV, BS, BSD, Tb.Th, Tb.N, FD, and BS/BV) (P<0.01) while SPF demonstrated significant negative correlations with other microstructural parameters (Tb.Sp, Tb.Pf, and SMI) using micro-CT and CBCT (P<0.01). CONCLUSIONS: There was an increase in implant stability prediction by combining BV/TV and SMI in the stepwise forward regression analysis. Bone with high volume density and low surface density shows high implant stability. Well-connected thick bone with small marrow spaces also shows high implant stability. The combination of bone density and architectural parameters measured using CBCT can predict the implant stability more accurately than the density alone in clinical diagnoses.
Bone and Bones ; Bone Density ; Bone Marrow ; Cone-Beam Computed Tomography* ; Dental Implants* ; Diagnosis ; Swine ; X-Ray Microtomography

No abstract available.
Echocardiography* ; Humans ; Mitral Valve*

PURPOSE: This study tried to find the most significant factors predicting implant prognosis using machine learning methods. MATERIALS AND METHODS: The data used in this study was based on a systematic search of chart files at Seoul National University Bundang Hospital for one year. In this period, oral and maxillofacial surgeons inserted 667 implants in 198 patients after consultation with a prosthodontist. The traditional statistical methods were inappropriate in this study, which analyzed the data of a small sample size to find a factor affecting the prognosis. The machine learning methods were used in this study, since these methods have analyzing power for a small sample size and are able to find a new factor that has been unknown to have an effect on the result. A decision tree model and a support vector machine were used for the analysis. RESULTS: The results identified mesio-distal position of the inserted implant as the most significant factor determining its prognosis. Both of the machine learning methods, the decision tree model and support vector machine, yielded the similar results. CONCLUSION: Dental clinicians should be careful in locating implants in the patient's mouths, especially mesio-distally, to minimize the negative complications against implant survival.
Decision Trees ; Dental Implants ; Dentists ; Humans ; Machine Learning ; Methods ; Mouth ; Oral and Maxillofacial Surgeons ; Pilot Projects ; Prognosis ; Sample Size ; Seoul ; Support Vector Machine