Background: Brain MRI may unexpectedly display abnormalities in splenium of the corpus callosum (SCC). However, the clinical implications of this lesion are unclear and are not always consistent with ischemic infarctions. We performed this study to clarify the clinical and radiological implications in patients with SCC lesions. Methods: We retrospectively reviewed consecutive patients with MRIreported SCC changes between 2009 and 2012. We analyzed clinical and radiological findings, etiologies, cognitive impairment, and clinical outcomes. Results: We found 30 patients (16 females; mean 50.5 years) who had SCC lesions on MRI. Confusion was the most common clinical finding in 50% of cases. Cerebral infarction was the most common etiology (50%). The most consistent SCC changes on MRI were low signal in T1WI, high signal on T2WI and FLAIR, and high signal on DWI. We classified SCC lesions into in situ SCC lesions (SCC only) and multiple (SCC plus) lesions for patients with multiple lesions. The clinical symptoms of SCC only lesions were relatively mild. Cognitive functions were evaluated by Mini Mental State Examination (MMSE) and clinical dementia rating (CDR) scale at the time of discharge and patients with SCC only lesions showed less impaired cognition compared with those with SCC plus lesions. Clinical outcomes were evaluated by the modified Rankin scale at 1 month and patients with SCC only lesions revealed good clinical outcomes compared with those with SCC plus lesions. Conclusions: MRI-reported SCC lesions may have heterogeneous etiologies and present with various symptoms. The clinical course and outcome are relatively good, particularly in small isolated and oval shaped SCC lesions.

Background & Objective: Hiccups is a disabling condition of lateral medullary infarction (LMI). Unlike other symptoms of LMI, the anatomical lesions of hiccups are not well known. Few studies have evaluated the relationship between the lesional location of LMI and hiccups. We performed this study to correlate hiccups and magnetic resonance imaging (MRI)-based lesional location in pure LMI. Methods: Between January 1997 and February 2013, we identified 24 patients with pure LMI who presented with hiccups in addition to typical lateral medullary syndrome. Sixty six pure LMI patients without hiccups were included as a control group. Clinical and radiologic findings were compared between the two groups. MRI-identified lesions were classified rostrocaudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. Results: The pure LMI patients with hiccups had significantly more frequent aspiration pneumonia (P = 0.001) and longer hospital stay (P = 0.03). The patients with hiccups significantly more often had dorsal rather than ventral lesion at horizontal levels (P = 0.012). But, there were no rostro-caudal differences at vertical levels (P = 0.162). Conclusions: We suggest that pure LMI associated with hiccups often locates in the dorsal medulla at horizontal correlation. This MRI-based comparative study has advanced the understanding of the neural substrate for hiccups in LMI, and indicates that hiccups become predictable when specific lesional locations in the lateral medulla are considered.

BACKGROUND: The bispectral index, a parameter of electroencephalography (EEG) and a tool for the measurement of sedative state has been used in general anesthesia and for the assessment of sedative degree in intensive care units. The adverse effects of inhalation agents are various although hepatic toxicity, renal toxicity, postoperative nausea, and vomiting have been reported. This study was designed to evaluate the adverse effect of inhalation agents. METHODS: Forty-four adult patients scheduled for thyroidectomy under general anesthesia were randomly assigned to one group with a BIS below 40 (BIS40 group, n = 23) or to a group with a BIS from 50 to 60 (BIS60 group, n = 21). Hgb, WBC count, PLT count, renal function, and liver function were measured pre-and post-operatively (after 24 hrs). The degree of postoperative nausea and vomiting were estimated using the Rhodes Index of Nausea, Vomiting and Retching (RINVR) in postoperative 6 hrs, 12 hrs and 24 hrs. RESULTS: The amount of fentanyl used during the operation were greates in the BIS60 group than in the BIS40 group for adequate analgesia, and the preoperative and postoperative values of Hgb, WBC count, PLT count, AST, ALT, ALP, s-BUN, and s-creatine were not significantly different between the BIS40 and BIS60 groups. 6 hrs, 12 hrs and 24 hrs post-operatively no differences were observed between groups by RINVR in terms of nausea and vomiting. CONCLUSIONS: The adverse effect of an inhalation agent appears not to be related to its concentration when sevoflurane with BIS monitoring are used to reduced the amount of agent inhaled.
Adult ; Analgesia ; Anesthesia* ; Anesthesia, General ; Electroencephalography ; Fentanyl ; Humans ; Inhalation ; Intensive Care Units ; Liver ; Nausea ; Postoperative Nausea and Vomiting ; Thyroidectomy ; Vomiting

OBJECTIVES: The objective of this study was to investigate the effect of chain installation condition on stress distribution that could eventually cause disastrous failure from sudden deformation and geometric rupture. METHODS: Fractographic method used for the failed chain indicates that over-stress was considered as the root cause of failure. 3D modeling and finite element analysis for the chain, used in a crane hook, were performed with a three-dimensional interactive application program, CATIA, commercial finite element analysis and computational fluid dynamic software, ANSYS. RESULTS: The results showed that the state of stress was changed depending on the initial position of the chain that was installed in the hook. Especially, the magnitude of the stress was strongly affected by the bending forces, which are 2.5 times greater (under the simulation condition currently investigated) than that from the plain tensile load. Also, it was noted that the change of load state is strongly related to the failure of parts. The chain can hold an ultimate load of about 8 tons with only the tensile load acting on it. CONCLUSION: The conclusions of this research clearly showed that a reduction of the loss from similar incidents can be achieved when an operator properly handles the installation of the chain.
Accidents, Occupational ; Aluminum Hydroxide ; Carbonates ; Finite Element Analysis ; Hydrodynamics

OBJECTIVES: The objective of this study was to investigate the effect of chain installation condition on stress distribution that could eventually cause disastrous failure from sudden deformation and geometric rupture. METHODS: Fractographic method used for the failed chain indicates that over-stress was considered as the root cause of failure. 3D modeling and finite element analysis for the chain, used in a crane hook, were performed with a three-dimensional interactive application program, CATIA, commercial finite element analysis and computational fluid dynamic software, ANSYS. RESULTS: The results showed that the state of stress was changed depending on the initial position of the chain that was installed in the hook. Especially, the magnitude of the stress was strongly affected by the bending forces, which are 2.5 times greater (under the simulation condition currently investigated) than that from the plain tensile load. Also, it was noted that the change of load state is strongly related to the failure of parts. The chain can hold an ultimate load of about 8 tons with only the tensile load acting on it. CONCLUSION: The conclusions of this research clearly showed that a reduction of the loss from similar incidents can be achieved when an operator properly handles the installation of the chain.
Accidents, Occupational ; Aluminum Hydroxide ; Carbonates ; Finite Element Analysis ; Hydrodynamics

BACKGROUND: Vitiligo has been associated with various disorders including pernicious anemia, diabetes, hyperthyroidism, hypothyroidism, alopecia areata, Addison's disease, and so on. Autoantibodies against specific organs are also frequently found. However, the positive rates of these autoantibodies' detection by various reporters showed too much diversity to extrapolate a definitive conclusion. OBJECTIVE: The purpose of this study was to investigate the autoimmune aspects of vitiligo by evaluating the detection rates of various organ-specific autoantibodies. METHODS: We classified vitiligo patients into 2 groups(autoantibody positive group and autoantibody negative group) and 3 types(localized, generalized, and universalis). The overall detection rates of various autoimmune and endocrine diseases were also assessed in patients and the control, which was composed of 40 young healthy volunteers. RESULTS: There were 106 males(33.0%) and 215 females(67.0%) in total 321 vitiligo patients. 115 patients(35.8%) were determined to be autoanitibody positive, and 206 patients(64.2%) were negative. The most frequent type of vitiligo was generalized type in both autoantibody positive and negative group. Mean age of onset was 30.8 years. And there was a statistically significant difference between autoantibody positive(37.6 years) and negative(29.3 years) group(p < 0.05). Average disease duration was 6.5 years in autoantibody positive group and 4.3 years in autoantibody negative group. The positive rates of anti-nuclear, anti-microsomal. anti-smooth muscle antibody, and rheumatoid factor showed no significant differences between vitiligo patients and normal control group(p > 0.05). But the positive rate of antithyroid antibody was significantly higher in vitiligo patients than in normal control(kappa2 = 4.234, p = 0.040). The prevalence rates of autoimmune & endocrine disorders showed no significant differences between vitiligo patients and normal control(p>0.05). The prevalence rates of autoimmune and endocrine disorders were higher in autoantibody positive vitiligo group(33.0%) than in negative group(29.6%), although it was not statistically significant(p>0.05). However, the prevalence rate of thyroid disease itself was significantly higher in autoantibody positive group than in negative group(p = 0.004). Treatment response to PUVA therapy was better in autoantibody positive group than in negative group(p = 0.0003). CONCLUSION: With these results, we were able to conclude that anti-thyroglobulin antibody is more frequently found in vitiligo patients than in normal control. And autoantibody positive vitiligo patients showed higher prevalence rate of thyroid disease and better treatment response to PUVA therapy than in autoantibody negative vitiligo patients. Therefore, the presence of autoantibody in vitiligo patients seems to be related with a better treatment response for PUVA therapy.
Addison Disease ; Age of Onset ; Alopecia Areata ; Anemia, Pernicious ; Autoantibodies* ; Endocrine System Diseases ; Healthy Volunteers ; Humans ; Hyperthyroidism ; Hypothyroidism ; Prevalence ; PUVA Therapy ; Rheumatoid Factor ; Thyroid Diseases ; Vitiligo*

Objectives: This study examined the validity of the Childhood Autism Rating Scale, Second Edition (CARS-2) compared with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in identifying autism spectrum disorder (ASD). Methods: A total of 237 children were tested using both the CARS-2 and ADOS-2. We examined the correlation using Pearson’s correlation analysis. In addition, we used a receiver operating characteristic graph to determine the optimal standard version of the CARS-2 (CARS2-ST) cutoff score for ASD diagnosis using the ADOS-2. Results: The concurrent validity of the CARS2-ST was demonstrated by a significant correlation with the ADOS-2 (r=0.864, p<0.001). The optimal CARS2-ST cutoff scores were 30 and 28.5 for identifying autism and autism spectrum, respectively, based on the ADOS-2. Conclusion We suggest a newly derived CARS2-ST cutoff score of 28.5 for screening ASD and providing early intervention.

BACKGROUND: To minimize the side effects of radiofrequency trigeminal rhizotomy by making a more selective minimal lesion for the target division of a trigeminal rootlet, we performed this study to evaluate the effectiveness and the selectivity of radiofrequency trigeminal rhizotomy using a 2 mm active tip electrode as compared to a 5 mm active tip electrode. METHODS: The authors evaluated 36 cases, in which radiofrequency thermocoagulation of a trigeminal rootlet was performed using a 2 mm active tip electrode or a 5 mm active tip electrode at 75oC for 60 seconds in patients suffering from trigeminal neuralgia. One month after each operation, we assessed the clinical effects, selectivity, and the side effects of these operations. RESULTS: Of the 36 patients, 34 patients experienced loss of tic pain. In terms of effectiveness, no difference was found between the two groups. In terms of selectivity, some superiority was shown by the 2 mm active tip electrode, but this was not statistically significant. Masseter weakness or dysesthesia occurred in six patients who suffered from tic pain in the V3 region, and who were operated upon with a 5 mm active tip electrode. Major complications like anesthesia dolorosa, and corneal anesthesia were absent in any patients. CONCLUSIONS: For target specific lesion generation of trigeminal rootlets, single lesion generation using a 2 mm active tip electrode may be as clinically effective as a 5 mm tip and is more selective in use.
Anesthesia ; Electrocoagulation ; Electrodes* ; Humans ; Paresthesia ; Rhizotomy* ; Tics ; Trigeminal Neuralgia*

OBJECTIVE: To evaluate the clinical usefulness of sonoelastography in infants with congenital muscular torticollis (CMT). METHODS: The medical records of 215 infants clinically diagnosed with CMT were retrospectively reviewed. Fifty-three infants met the inclusion criteria as follows: 1) infants diagnosed as CMT with a palpable neck mass before 3 months of age, 2) infants who were evaluated initially by both B-mode ultrasonography and sonoelastography, and 3) infants who had received physical therapy after being diagnosed with CMT. We checked the thickness of the sternocleidomastoid (SCM) muscles in B-mode ultrasonography, strain ratio of the SCM muscles in sonoelastography, and treatment duration. We evaluated the correlation between the treatment duration and the following factors: SCM muscle thickness, ratio of SCM muscle thickness on the affected to unaffected side (A/U ratio), and strain ratio. RESULTS: Both the thickness of the affected SCM muscle and the A/U ratio did not show significant correlation with the treatment duration (p=0.66, p=0.90). The strain ratio of the affected SCM muscle was significantly greater than that of the unaffected SCM muscle (p<0.001), and the strain ratio showed significant correlation with the treatment duration (p=0.001). CONCLUSION: Sonoelastography may be a useful adjunctive tool to B-mode ultrasonography for evaluating infants with CMT, especially when predicting their rehabilitation outcomes.
Elasticity Imaging Techniques* ; Humans ; Infant* ; Medical Records ; Muscles ; Neck ; Prognosis ; Rehabilitation ; Retrospective Studies ; Torticollis* ; Ultrasonography