Syringomyelia is a relatively uncommon, chronic, slowly progressive, degenerative process characterized by cavitation and gliosis within the substance of the spinal cord and/or the medulla. There have been only a few case reports in Korea. The authors reviewed 17 patients with syringomyelia diagnosed by delayed metrizamide spinal CT and/or MR imaging at Seoul National University Hospital from January, 1983 to June, 1987. Eleven were male and the age of onset was less than 40 in 16 (mean 23.4). The mean duration of symptoms was 87.1 months (range 3-276). Clinical features were similar to classical cases except sphincter involovement and abnormal sweating were more common in this report. The syrinx cavity which showed dye collection within spinal cord in delayed metrizamide spinal CT and low signal intensity in T1 weighted MR imaging was located mainly at cervicothoracic junction. The causes were the hindbran abnormality in 5, intramedullary cord tumor in 5, trauma in 3, adhesive arachnoiditis in 1 and unknown in 3. The cases with sensory dissociation had shorter duration of symptoms than those without sensory dissociation and showed normal results in SEPs study. Eleven patients were treated surgically and nine of them improved. MRI and SEPs are thought to be good aids for the understanding of the mechanism and course of syringomyelia.
Adhesives ; Age of Onset ; Arachnoid ; Arachnoiditis ; Gliosis ; Humans ; Korea ; Magnetic Resonance Imaging ; Male ; Metrizamide ; Seoul ; Spinal Cord ; Sweat ; Sweating ; Syringomyelia*

Objective: Frontal alpha asymmetry (FAA) of electroencephalography (EEG) has been studied to differentiate patients with major depressive disorder (MDD) from healthy controls (HC). However, inconsistent results have been obtained thus far. Suicidal ideation (SI) has been known to alter frontal lobe activity, and could be an important covariate in FAA studies. This study aimed to explore the influence of FAA on the relationship among MDD patients with SI and without SI, and HC. Methods: Sixty-seven patients with MDD (44 without and 23 with SI) and 60 HCs were recruited. Resting state EEG was recorded with their eyes open, and FAA as a lateralized index of alpha power was calculated in the frontal brain region. Hamilton Rating Scale for Anxiety and Depression scores were estimated. Results: FAA was higher (increased alpha power in the left frontal region) in the MDD group than in the HC group. The FAA was lower (reduced alpha power in the left frontal region) in MDD patients with SI than in MDD patients without SI. The severity of depression and anxiety symptoms were significantly correlated with FAA only in MDD patients with SI. SI moderated the effects of depressive symptom on FAA in the MDD group. Conclusion Our results suggest that SI is a clinically important moderator of frontal alpha asymmetry in patients with MDD.

OBJECTIVE: Quantitative electroencephalography (qEEG) has been increasingly used to evaluate patients with attention deficit hyperactivity disorder (ADHD). The aim of this study was to assess the correlation between qEEG data and symptom severity in patients with ADHD. METHODS: Fifteen patients with ADHD and 20 healthy controls (HCs) were recruited. Electroencephalography was assessed in the resting-state, and qEEG data were obtained in the eyes-closed state. The Korean version of the ADHD Rating Scale (K-ARS) and continuous performance tests (CPTs) were used to assess all participants. RESULTS: Theta-band (4-7 Hz) power across the brain was significantly positively correlated with inattention scores on the K-ARS, reaction times and commission errors on the CPTs in ADHD patients. Gamma-band (31-50 Hz) power was significantly positively correlated with the results of the auditory CPTs in ADHD patients. The theta/alpha (8-12 Hz) and theta/beta (13-30 Hz) ratios were significantly negatively correlated with commission and omission errors on auditory CPTs in ADHD patients. No significant correlations between qEEG relative power and K-ARS and CPT scores were observed in HCs. CONCLUSION: Our results suggest that qEEG may be a useful adjunctive tool in patients with ADHD.
Attention Deficit Disorder with Hyperactivity* ; Brain ; Electroencephalography* ; Humans ; Male* ; Reaction Time*

PURPOSE: In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and prognosis. MATERIALS AND METHODS: A total of 256 patients with gastric cancer who underwent curative surgery were included in this study. Microvessel count was determined by im-munohistochemical staining using monoclonal antibody against factor VIII-related antigen. RESULTS: The statistical significance between the microvessel count and clinicopathologic factors (age, sex, tumor invasion, lymph node involvement, histologic type) was analized. The tumor stage and histologic type were correlated with microvessel count. And also there was statistical significance with survival rate and recurrence-free survival rate between high (microvessel count> or =42) and low angiogeneic group (microvessel count< 42). The Cox's proportional hazard model showed that stage, histologic type, angiogeneic score were one of the significant and independent prognostic variables. CONCLUSION: The tumor angiogenesis of gastric carcinoma may be independent prognostic factor for predicting recurrence and survival.
Humans ; Lymph Nodes ; Microvessels ; Prognosis* ; Proportional Hazards Models ; Recurrence ; Stomach Neoplasms ; Survival Rate ; von Willebrand Factor

The effect of mannitol on serum osmolality(Sosm) was studied in 13 patients with increased intracranial pressure(Group I ) and 14 normal men(GroupII ). All of the Patients in Gtoup I were given 0.5 g/kg dose of mannitol radipidly and blood samples for Sosm were taken at 30 rninutes intetvals for the first one hour and at hourly intervals for the next 5 hours after mannitol infusion. Seven of Group II(Iia) received 0.5 g /kg dose of mannitol and the other 7 ( II b) received 1.0 g / kg, Blood samples for Sosm and electrolytes were taken at the same intervals for the same duration as in Group I expept for additionai blood samples every 5 rninutes during the first 30 minutes. In Group I there was no significant rise in Sosm even 30 minutes after mannitol infusion. In Group Iia and Iib, a maximum increase of 6 mOsm / kg, 14 mOsm / kg was observed at about 5 minutes, 25 minutes after mannitol infusion respectiveiy, which returned to baseline in about 1 hour and 4 hours respectively. The 1.0g /kg dose of mannitol produced a significant and relatively persistent increase in Sosm probably enough to reduce the ICP, but at dose of 0.5 g / kg there was minimal increase in Sosm; which seemed to be insufficient to reduce the ICP significantly as claimed in previous reports that there must be a Sosm rise of at least 10 mOsm / kg to have a significant reduction in ICP. Also, to detemine the loss of water and electrolytes through urine after mannitol administration, the urine volume and electrolytes were measeured at 30 minutes intervals for the first one hour and then every hour thereafter for six hours in normal men(Group II). Water and electrolytes excretion rates and urinary sodium concentrations were calculated in each interval. The author believes that these data would be useful in estimating the amount of water and electrolytes that has to be replaced.
Electrolytes* ; Humans ; Mannitol* ; Osmolar Concentration* ; Sodium

BACKGROUND: Standardized management and surveillance at a national level is essential to maintain blood product safety. Officials of the Korean Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, and Korean laboratory transfusion medicine specialists, currently participate as inspectors in the Korean National Blood Inspection Program for Blood Establishments. However, lack of definitive guidelines and absence of standardized inspector training programs compromise the goal of objective and consistent safety management results. In this study, we propose establishment of written inspection guidelines and a clearly documented accreditation training program. METHODS: Inspector training programs in the US and EU were reviewed online and the results of the Korean National Blood Inspection in our country performed during last 4 years were analyzed. RESULTS: We suggested inspection guidelines for every question of inspection checklists. Also, for the questions similar to those of Laboratory Accreditation Program of the Korean Society for Laboratory Medicine (KSLM), guidelines were proposed as 'Results of Laboratory Accreditation Program of the KSLM could be concerned if inspected laboratory obtained 2 year accreditation lately'. We suggest an 18hr-basic training program composed of lectures, e-learning and a visit to a blood center, as well as 12hr-continuing courses, should be established. CONCLUSION: To establish the Blood Inspection Program in a more systematic manner, thorough management and training of inspectors are essential. We expect the guidelines and training program for inspectors, suggested in our study, will be the cornerstone for creating a more professional quality management system and further ensure the safety of the national blood management system.
Accreditation ; Blood Safety ; Centers for Disease Control and Prevention (U.S.) ; Checklist ; Dietary Sucrose ; Humans ; Korea ; Lectures ; Safety Management ; Specialization

Primary cardiac lymphomas diagnosed antemortem are extremely rare. We present a case of primary cardiac lymphma diagnosed antemortem by transvenous biopsy under transesophageal echocardiographic guidance. The patient who was a 62 years old male presented with facial edema, dyspnea on exertion and syncope. The chest X-ray film showed double contour at right cardiac border and the ECG showed marked sinus bradycardia. Transesophageal echocardiography (TEE), chest computed tomography (CT) and magnetic resonance imaging (MRI) showed intracardiac tumor of right atrium, invasing interatrial septum and inlets of superior and inferior vena cava and lateral wall of right atrium. Abdominopelvic CT and bone scan failed to show any extracardiac location. Transvenous biopsy confirmed the diagnosis of malignant lymphoma (diffuse large cell, B cell type). After chemotherapy was begun, the tumor makedly shrunk and symptoms resolved. Primary cardiac lymphoma is extremely rare and almost uniformly fatal, but this case showed that early diagnosis and intensive che-motherapy might contribute to a better prognosis for patients with malignant lymphoma of the heart.
Bays ; Biopsy* ; Bradycardia ; Diagnosis* ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Edema ; Electrocardiography ; Heart ; Heart Atria ; Humans ; Lymphoma* ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prognosis ; Syncope ; Thorax ; Vena Cava, Inferior ; X-Ray Film

Purpose: We investigated the clinical efficacy of immune checkpoint blocker (ICB) therapy for metastatic or advanced melanoma in Korean patients. As well, we assessed whether the effects of ICBs can be enhanced by combination therapy with palliative radiotherapy (RT). Materials and Methods: We retrospectively reviewed the records of 127 patients with metastatic melanoma who received ICB with or without palliative RT between 2014 and 2018. The melanoma subtypes were classified as follows: chronic sun-damaged (CSD), acral, mucosal, and uveal. The primary endpoint was the objective response rate (ORR). Results: The overall ORR was 15%, with 11 complete and eight partial responses. ORRs for CSD, acral/mucosal, and uveal melanomas were 50%, 16.5%, and 0%, respectively (p=0.009). In addition to the subtype, stage at treatment, total tumor burden at treatment, and ICB type were significantly associated with ORR (all p < 0.05). Palliative RT was administered in 44% of patients during the treatment, and it did not affect ORR. Clinical responders to ICB therapy exhibited significantly higher 1-year progression-free and overall survival rates than nonresponders. Conclusion ORR for ICB monotherapy in Korean patients with melanoma is relatively modest compared with that in Western patients because the non-CSD subtypes are predominant in the Korean population. Our findings regarding combination therapy with ICB provided a rationale for the initiation of our phase II study (NCT04017897).

PURPOSE: There is no standard second-line regimen for malignant melanoma patients with disease progression after first-line chemotherapy, and platinum-alkylating agents combined with paclitaxel have shown modest efficacy. MATERIALS AND METHODS: We conducted a phase II, open-label, single-arm study to test the efficacy of docetaxel combined with carboplatin for malignant melanoma patients who failed previous treatment with dacarbazine. Intravenous docetaxel (35 mg/m2 on days 1 and 8 of each cycle) and carboplatin (area under the curve 3 on days 1 and 8 of each cycle) was administered every 21 days. Primary end point was objective response rate (ORR). RESULTS: Thirty patients were enrolled in the study, and the median follow-up duration was 19.8 months. Among 25 per-protocol patients, there were three responders (1 with complete response and 2 with partial response) and 17 stable disease patients (ORR, 12.0%). Among the per-protocol population, the median progression-free survival (PFS) was 4.3 months and the median overall survival (OS) was 9.6 months. Uveal melanoma patients (n=9) showed the best prognosis compared to other subtypes (median PFS, 7.6 months; OS, 9.9 months). The most common grade 3 or 4 adverse event was neutropenia (n=15, 50.0%). CONCLUSION: Docetaxel combined with carboplatin showed association with an acceptable safety profile and overall efficacy for patients with malignant melanoma who had progressed on chemotherapy containing dacarbazine.
Carboplatin* ; Dacarbazine* ; Disease Progression ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Melanoma* ; Neutropenia ; Paclitaxel ; Prognosis

OBJECTIVE: To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. MATERIALS AND METHODS: Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. RESULTS: Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). CONCLUSION: Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease.
Alzheimer Disease* ; Biomarkers ; Brain ; Cerebrum ; Humans ; Magnetic Resonance Imaging ; Neuroimaging* ; Parietal Lobe ; Retrospective Studies ; Support Vector Machine ; Temporal Lobe