OBJECTIVES: The multiple sleep latency test (MSLT) is commonly used as a valid objective measure of sleepiness. The procedure of MSLT is well standardized but the sleep onset criterion is somewhat variable. One epoch of stage 1 sleep is the most commonly used criterion, and the criterion of three epochs of stage 1 sleep is also used. The purpose of this study was to compare the two criteria used to determine sleep onset. METHODS: We retrospectively analyzed 60 consecutive MSLT that were performed according to a standaridized protocol. We scored each test using the two different criteria for sleep onset and then statistically analyed the results. RESULTS: Using the different criteria, 20 patients among 60 showed changes in mean sleep latency (33.3%). The extent of change ranged from 1.3% to 38.5% (mean 15.9%). Non-narcoleptic patients showed a significantly higher incidence of change than other sleep disorder patients. CONCLUSION: Changes in mean sleep latency occurred according to the different criteria of sleep onset. But the difference arising from different criteria was statistically not significant in patients with moderate to severe sleepiness. Considering that 1 epoch criterion for sleep onset is more sensitive in detecting clinically significant sleepiness, the authors suggest that the 1 epoch criterion is more reliable than the 3 epochs criterion.
Humans ; Incidence ; Retrospective Studies

Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature.
Ear, Inner ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hemorrhage* ; Magnetic Resonance Imaging ; Neuroma, Acoustic ; Prognosis

Ramsay Hunt Syndrome was initially described by Ramsay Hunt in 1907 as herpes zoster of the geniculate ganglion. The frequency of RHS in patients with herpes zoster has been calculated to be about 1%. RHS affects mostly adults; however a small number of children with herpes zoster oticus have been reported. We describe a case of RHS in a healthy 39/12-year-old boy. A complete peripheral facial palsy on the left side was noted as well as vesicles of herpes zoster type on the pinna of the same side. The analysis of sera confirmed the clinical diagnosis of RHS with a positive IgG-ELISA antibody titier. Treatment of acyclovir was tried for 7 days, starting 2 days after facial palsy was objerved. In addition, oral prednisolon, divided into two doses per day, was administered for 5 days and then tapered to zero over the following 10 days. Complete recovery observed after 1 month.
Acyclovir ; Adult ; Child ; Diagnosis ; Facial Paralysis ; Geniculate Ganglion ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Male

PURPOSE: The goal of this study was to evaluate the impact of life style characteristics on the prevalence risk of metabolic syndrome (MS). METHODS: A total of 581 adults were recruited from a cardiovascular outpatient clinic. A newly developed comprehensive life style evaluation tool for MS patients was used, and patient data related to the MS diagnosis were reviewed from the hospital records. RESULTS: The overall prevalence of MS was 53.2%, and the mean of MS score was 2.6 for patients at a cardiovascular outpatient clinic (78% of the patients had hypertension). Dietary habits among the life style characteristics had significant influence on the prevalence risk of MS and MS scores. And also interestingly, the classification and regression tree (CART) model suggested that the high prevalence risk groups for MS were older adults (61.5< or =age<79.4), and adults between 48.5 and 61.5 yr of age with bad dietary habits. CONCLUSION: This study indicates that nurses should focus on dietary habits of patients (especially patients classified as high prevalence risk for MS) for improvement and prevention of MS prevalence risk.
Age Factors ; Aged ; Alcohol Drinking ; Demography ; Female ; Food Habits ; Humans ; *Life Style ; Male ; Metabolic Syndrome X/diagnosis/epidemiology/*psychology ; Middle Aged ; Odds Ratio ; Prevalence ; Risk ; Smoking ; Stress, Psychological

STUDY DESIGN: 3 cases report. OBJECTIVES: We present 3 cases of cervical myelopathy treated successfully by selective laminoplasty on 2 levels or less, using Kurokawa technique with a review of the relevant articles. SUMMARY OF LITERATURE REVIEW: As there were no clear criteria for the numbers of the laminae that require decompression in a standard laminoplasty, a wide level laminoplasty from C3 to C7 has been generally done. As a result, complications such as axial pain, C5 root paresis, and loss of range of motion have been reported commonly. To reduce these complications, recent studies have attempted less invasive procedures, such as selective laminoplasty or preservation of posterior ligament and muscle components. MATERIALS AND METHODS: There were two cases of developmental stenosis and one posterior compressive stenosis that underwent selective laminoplasty. The posterior shift of the spinal cord and the dural expansion were measured by magnetic resonance imaging at 3 or 4 weeks after surgery. Clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score. Axial pain was classified as follows; never: Grade 0; mild: Grade 1; moderate: Grade 2; and severe: Grade 4. RESULTS: The spinal cord had a tendency to shift posterioly and the dura mater was expanded in all cases. Clinical outcomes and axial pain were also improved in all. CONCLUSIONS: Selective laminoplasty that enabled the surgeon to perform a less invasive surgery preserving operative time and the patient to have a lower risk of C5 root paresis is effective for the developmental stenosis or posterior compressive stenosis less than 3 levels.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Dura Mater ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Operative Time ; Orthopedics ; Paresis ; Range of Motion, Articular ; Spinal Cord ; Spinal Cord Diseases

OBJECTIVE: The purpose of this study was to evaluate the surgical technique and outcome of mini-open posterior lumbar interbody fusion (PLIF) under circumferential releasing technique. METHODS: Fourty patients who underwent mini-open PLIF using the percutaneous screw fixation system for Meyerding Grade II spondylolisthesis or more were retrospectively studied. After complete circumferential release, the slipped vertebrae would tend to obtain spontaneous reduction, and with compressive force by percutaneous screw fixation, additional reduction could be achieved. The radiological measurements including slippage reduction, disc height, restoration of lumbar lordotic angle and focal segmental angle were analyzed. The clinical outcome was assessed using the visual analog scale (VAS) and low back outcome score (LBOS), and procedure related complications were also analyzed. RESULTS: Slippage percentage was improved from 38.0+/-12.6% to 9.3+/-7.8% and lumbar lordotic angle was changed from 43.0+/-13.8degrees to 48.2+/-10.3degrees. Focal segmental angle improved from 10.1+/-8.5degrees to 15.9+/-6.0degrees. The mean LBOS and mean pain score were also improved significantly. Complications included one case of medial penetration of pedicle border and two cases of transient radiculopathy. However, there were no signs of neurological aggravation or fusion failure during the follow-up period. CONCLUSION: Mini-open PLIF using the percutaneous screw fixation following complete circumferential release can be safe and effective treatment for even moderate to severe grade spondylolisthesis.
Follow-Up Studies ; Humans ; Radiculopathy ; Retrospective Studies ; Spine ; Spondylolisthesis* ; Visual Analog Scale

Early gastric cancer (EGC) is a "curable" disease with a high cure rate made possible through proper surgical treatment; nonetheless, some patients sustain a disease recurrence after curative resection. The aim of this study was to identify the clinicopathological characteristics of recurrent EGC and determine predictable immunohistochemical markers for recurrence. We investigated the clinicopathological features of 1,786 EGC cases, and using tissue microarray, the expression of c-erbB-2, EGFR, MLH1, MSH2, p53, and AQP1 was examined in group with recurrence and control group without recerrence. In the clinical analysis, 32 of 1,786 (1.79%) patients showed recurrence, with a 2.04% five-year cumulative recurrence rate. Age, submucosal invasion, and lymph node metastasis significantly correlated with tumor recurrence (P=0.044, 0.019, and <0.001, respectively). Multivariate analysis showed lymph node status and old age (> or =57 yr) as independent risk factors of recurrence. In a case-control study, immunopositivity for c-erbB-2 was significantly associated with disease recurrence (P=0.024). There is the probability that EGC patients with old age (> or =57 yr), lymph node metastasis, submucosal invasion, and c-erbB-2 immunopositivity will experience recurrence; therefore, it is critical that patients with these risk factors be followed-up closely and considered candidates for adjuvant treatment.
Adult ; Aged ; Animals ; Female ; Genes, erbB-2 ; Humans ; Immunohistochemistry/methods ; Male ; Microarray Analysis/methods ; Middle Aged ; Multivariate Analysis ; *Neoplasm Recurrence, Local/metabolism/pathology ; Prognosis ; Risk Factors ; *Stomach Neoplasms/metabolism/pathology ; Tumor Markers, Biological/*metabolism

BACKGROUND AND OBJECTIVES: It has been reported that various inflammatory and immune reactions are involved in the development and progression of atherosclerosis. We tried to investigate whether the TNF receptor superfamilies are involved in the development and progression of atherosclerosis. MATERIALS AND METHOD: Thirteen carotid atheroma specimens(frozen sections : 10 cases, paraffin section : 5 cases) were obtained from the patients who underwent carotid endarterectomy at Samsung Medical Center and one normal aortic tissue was obtained from a transplantation donor in brain death. In the carotid endarterectomy specimens and a normal aortic tissue , the expressions of R110(TR1), 139(TR2) and DR3(TR3), members of the TNF receptor superfamilies were evaluated by immunohistochemical staining with monoclonal antibodies. Simultaneously, we evaluated the expressions of foam cells, smooth muscle cells, T-lymphocytes and B-lymphocytes. RESULTS: Immunohistochemical analysis identified a strong expressions of foam cells and smooth muscle cells in all atheroma. But, the expression of T-lymphocytes was minimal and that of B-lymphocytes was rare. The expression of DR3(TR3) was seen in all atheroma as strongly positive. The expression of 139(TR2) was observed well in frozen sections, but not in paraffin sections. Whereas, that of R110(TR1) was observed in paraffin sections as weakly positive, but not in frozen section. The areas where the TNF receptor superfamilies were expressed correlated to the area of foam cell presence. The expression of DR3 also correlated with expression of smooth muscle cells. In normal aortic tissue, the expression of inflammatory cells or TNF receptor superfamilies was not observed except smooth muscle cells which were observed in normal artery. CONCLUSION: Foam cells and smooth muscle cells were abundantly present in atheroma. The TNF receptor superfamilies are expressed in the atheroma and the region of expression was coincident with the presence of foam cells.
Antibodies, Monoclonal ; Arteries ; Atherosclerosis ; B-Lymphocytes ; Brain Death ; Endarterectomy, Carotid ; Foam Cells ; Frozen Sections ; Humans ; Myocytes, Smooth Muscle ; Paraffin ; Plaque, Atherosclerotic* ; Receptors, Tumor Necrosis Factor* ; T-Lymphocytes ; Tissue Donors ; Tumor Necrosis Factor-alpha*

High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.
Diaphyses ; Fibula ; Head ; Joints ; Methods ; Neck ; Osteoarthritis ; Osteotomy ; Paralysis ; Peroneal Nerve ; Tibia

PURPOSE: To evaluate the relevant clinical and radiographical findings for the diagnosis of an arteriovenous fistula after a lumbar discectomy. MATERIALS AND METHODS: Five patients with an arteriovenous fistula following a lumbar discectomy were preoperatively diagnosed and treated. We retrospectively evaluated the level of surgery, injured vessels, clinical symptoms, physical findings, and the interval between surgery and treatment. Effective and fast diagnostic methods for determining the presence of a postoperative arteriovenous fistula were evaluated. RESULTS: All of the arteriovenous fistulas resulted from operative injuries of the iliac arteries and veins. They were diagnosed after a mean time of 22 months (range 2 months-4 years) in spite of various symptoms and signs shortly after surgery. The arteriovenous fistulas were confirmed with angiography and were treated by surgery for 3 patients and by insertion of a stent-graft in 2 patients. Postoperative CT angiography showed the complete occlusion of the fistula tract and the normal blood flow. CONCLUSION: Essential clinical information and radiological examination, especially CT angiography with 3D reconstruction, is necessary to obtain to diagnose an arteriovenous fistula after a lumbar discectomy.
Angiography ; Arteriovenous Fistula* ; Diagnosis* ; Diskectomy* ; Fistula ; Humans ; Iliac Artery ; Retrospective Studies ; Veins