BACKGROUND AND OBJECT: Cheiro-oral syndrome (COS) is characterized by a sensory disturbance in the unilateral hand and ipsilateral mouth corner. It is usually due to a lesion in the parietal cortex, thatamocortical projections, thalamus, or rarely brain stem. However, the syndrome is relatively unknown and rarely mentioned in most neurological textbooks. We presented ten cases of COS with a review of the clinical symptoms and signs and the neuroradiological methods used to demonstrate the responsible site. METHODS AND RESULTS: We studied 10 patients with stroke who showed restricted sensory disturbance on the one hand and ispilateral mouth. The study forms consisted of clinical manifestaion, neurological examination, electrophysiological, and neuroradiologic studies. Computed tomography and/or magnetic resonance imaging identified lesion in the thalamus in 5, brain stem in 3, and corona radiata in 1 patient. But, the anatomical responsible site for one case was not founded. Infarction had occurred in nine cases and hemorrhage in one. Seven of the 10 patients showed sensory disturbances restricted to the perioral area, hands, fingers when they were first examined; the remaining patients complained more diffuse sensory disturbances at first, but it had become restricted to perioral and fingers, usually within 2-3 weeks. The durations of symptom varied from 5 days to more than 15 months and these symptoms were improved within 2-3 weeks to 4 months in treated patients. CONCLUSION: When the symptoms and signs of the COS were presented, especially if a history of migraine is lacking, neuroradiological methods such as CT or MRI should be undertaken to localize and diffentiate the nature of lesion.
Brain Stem ; Fingers ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging ; Migraine Disorders ; Mouth ; Neurologic Examination ; Rabeprazole ; Stroke ; Thalamus

OBJECTIVE: This study was conducted to evaluate the impairment of cognitive functions, which include verbal and visual memory, visuospatial function, and executive function, and also to investigate if there is improvement of cognitive impairment after antidepressant treatment in patients with major depressive disorder (MDD). METHODS: Fifteen female patients with non-psychotic MDD in mild to moderate severity and 25 age-matched female normal control subjects participated in this study. Clinical severity of depression was measured by Beck Depression Inventory (BDI), Zung's Self-Rating Depression Scale (Zung), and Hamilton Rating Scale for Depression (HAMD). Cognitive functions were tested using Ray Complex Figure Test (RCFT) to evaluate visuospatial function and visual memory, Stroop test to evaluate conflict monitoring, Wisconsin Card Sorting Test (WCST) to evaluate executive function, and Seoul Verbal Learning Test (SVLT) to evaluate verbal memory. Both clinical depression scales and cognitive function tests were conducted at baseline and after 12 months of antidepressant treatment. RESULTS: At baseline, there were deficits in immediate and delayed recall of SVLT in patients with MDD compared to normal control subjects, while the impairment in visuospatial function, visual memory, and executive function was not clear. After antidepressant treatment, improvement of executive function, i.e. percent of error response and perseverative response of WCST in MDD patients was greater than that in normal control subjects. Improvement of executive function, however, did not show a significant correlation with the change of clinical severity of depression. CONCLUSION: The verbal memory was the most prominent domain of cognitive dysfunction in non-psychotic depression with mild to moderate severity. Of further note, differential improvement in executive function was observed in MDD patients after antidepressant treatment, although the improvement in executive function was not directly associated with the improvement of clinical depression.
Depression ; Depressive Disorder, Major ; Executive Function ; Female ; Humans ; Memory ; Prospective Studies ; Stroop Test ; Verbal Learning ; Weights and Measures ; Wisconsin

OBJECTIVES: The study was performed to compare the quality of life and mental health -depression, suicide etc- in homosexual men with those in heterosexual men and to identify how the quality of life is related with mental health. METHODS: 129 homosexual men and 114 heterosexual men in twenties and thirties were enrolled by crosssectional method. Quality of life, depression, suicidal idea, hopelessness, self esteem, coping strategy, social support, social conflict, familiar adaptability and familiar cohesion were measured by self-report scale to compare the homosexual and the heterosexual groups. RESULTS: The results showed that age, educational level, income, alcohol intake, smoking and reli-gion were not significantly different between homosexual group and heterosexual group. Teased experience about feminity, past psychiatric history, HIV test experience in homosexual group were higher than those in heterosexual group. The self- esteem, hopelessness, coping strategy, familiar ada-ptability and social support-conflict were not significantly different between two groups. Homosexual group had poorer quality of life, lower familiar cohesion, higher depression and higher suicidal idea than heterosexual group. Being alienated from home, social system and interpersonal relationship, which are subscales of the quality of life, scored lower by homosexual group as compared with hete-rosexual group. Therefore, high depression and low familiar cohesion had significant effect on the quality of life in homosexual group. CONCLUSION: Although homosexuality is excluded from DSM, the prevalences of many mental health problems are higher in homosexual group than heterosexual group. It is suggested that the more studies on depression and familiar function related to homosexuality are needed.
Depression ; Emigrants and Immigrants ; Heterosexuality* ; HIV ; Homosexuality* ; Humans ; Male ; Mental Health* ; Prevalence ; Quality of Life* ; Self Concept ; Smoke ; Smoking ; Suicide

BACKGROUND: The prevalence of obesity is increasing year after year in Korean; and gastroesophageal reflux disease(GERD) is increasing in this population as well. The aim of this study is to assess the association between age, body mass index(BMI) and GERD in healthy Korean adults. METHODS: Analysis was done on 1,016 subjects who had not had malignancy, uncontrolled metabolic disease, enteric surgery and organic esophageal disease. They completed a questionnaire that included past history and reflux symptoms. Endoscopy was performed by two gastroenterologists who were not given any patient information. Existence of GERD was determined by the esophageal syndrome criteria of the Montreal guidelines. Subjects were categorized by BMI, initially as: underweight, normal(18.5< or =BMI<25), overweight(25< or =BMI<30) and obese by the WHO criteria, and then as: underweight, normal(18.5< or =BMI<23), overweight(23< or =BMI<25) and obese by the Asian-Pacific criteria. RESULTS: The overall[is this correct] prevalence of GERD in our subjects was 15.5%. Age and sex were not correlated factors for GERD. By the WHO and the Asian-Pacific criteria, GERD was present in underweight(10.0%, 12.1%), normal(13.9%, 14.4%), overweight(18.6%, 13.0%) and obese groups(21.0%, 18.8%). No meaningful association was seen between BMI and GERD in either of the classified groups. Erosive GERD was seen in 83 subjects (8.2%) on endoscopy. The obese(BMI> or =25) group(12.1%) showed a meaningful increment in the prevalence of erosive GERD compared to the non-obese(BMI<25) group(6.2%)(p value 0.002). CONCLUSION: The prevalence of GERD in healthy Korean adult subjects was not closely associated with obesity and age[according to BMI]; however, erosive GERD was found to have a strong association with obesity.
Adult ; Body Mass Index ; Endoscopy ; Esophageal Diseases ; Gastroesophageal Reflux ; Humans ; Metabolic Diseases ; Obesity ; Prevalence ; Surveys and Questionnaires ; Thinness

OBJECTIVE: Two-dimensional fluoroscopy-based computerized navigation for the placement of pedicle screws offers the advantage of using stored patient-specific imaging data in providing real-time guidance during screw placement. The study aimed to describe the accuracy and reliability of a fluoroscopy-based navigation system for pedicle screw insertion. METHODS: A total of 477 pedicle screws were inserted in the lower back of 96 consecutive patients between October 2007 and June 2012 using fluoroscopy-based computer-assisted surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol. RESULTS: Of the 477 pedicle screws, 461 (96.7%) were judged to be inserted correctly. Frank screw misplacement [16 screws (3.3%)] was observed in 15 patients. Of these, 8 were classified as minimally misplaced (< or =2 mm); 3, as moderately misplaced (2.1-4 mm); and 5, as severely misplaced (>4 mm). No complications, including nerve root injury, cerebrospinal fluid leakage, or internal organ injury, were observed in any of the patients. CONCLUSION: The accuracy of pedicle screw placement using a fluoroscopy-based computer navigation system was observed to be superior to that obtained with conventional techniques.
Cerebrospinal Fluid ; Humans ; Surgery, Computer-Assisted

OBJECTIVE: Risperidone, one of the most widely used atypical antipsychotics, not only ameliorates the positive symptoms of the acute phase but also improves the long-term quality of life as well. To achieve sufficient therapeutic effects, it is important to readjust the treatment regimen in case of insufficient response at an appropriate time point. However, few studies have dealt with this issue in clinical settings. METHODS: We investigated the past treatment history of 51 schizophrenics treated with risperidone for more than 48 weeks by retrospective chart review. The patients were divided into responders and non-responders by predetermined criteria, and CGI-severity scores at 7 selected time points were assessed. The time pattern of therapeutic responses was analyzed, and the appropriate point of time to reliably predict the long-term efficacy was sought. RESULTS: Thirty-one (60.8%) and 20 (39.2%) patients were respectively defined as responders and non-responders by our criteria. There was no difference in the risperidone dosage between responders and non-responders, at any time point evaluated. We observed that significant differences in the pattern of CGI-severity score between the two groups emerged after the 8th week, and that the treatment response profile during this phase might predict long-term outcome. CONCLUSION: The results of this study suggest that the 8-week point may be the most appropriate time to assess the clinical response to risperidone and to decide whether to continue with the regimen or change it. However, this was a naturalistic study and the study results require further confirmative research.
Antipsychotic Agents ; Humans ; Quality of Life ; Retrospective Studies ; Risperidone* ; Schizophrenia*

We have been using general anesthesia with thoracic epidural anesthesia to manage intrao-perative and postoperative pain for thoracic and cardiac surgery patients. Hemodynamic changes due to sympathetic block with epidural anesthesia is dependent on the level of sympathetic block. Thoracic epidural anesthesia block the cardiac sympathetic innervation, so there may be changes of cardiac function and pressure dependent coronary blood flow especially in coronary artery diseases. To investigate the effects of thoracic epidural anesthesia on coronary blood flow and hemodynamic changes, we performed thoracic epidural anesthesia by injection of 0.5% bupivacaine via a surgieally introduced catheter in dogs. The results were as follows ; 1) Coronary blood flow, systolic, mean and diastolic blood pressure, heart rate and cardiac output were decreased at 5 min, 10 min, 15 min, 20 min, 30 min, 45 min, 60 min, 90 min, 120 min after epidural injection of 0.5% bupivaeaine compared to control value (p<0.05). 2) Systemie vascular resistance, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume and pulmonary vascular resistance were not changed after epidural injection of 0.5% bupivacaine.
Anesthesia, Epidural* ; Anesthesia, General ; Animals ; Blood Pressure ; Bupivacaine ; Cardiac Output ; Cardiovascular System* ; Catheters ; Central Venous Pressure ; Coronary Artery Disease ; Dogs* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Epidural ; Pain, Postoperative ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Stroke Volume ; Thoracic Surgery ; Vascular Resistance

PURPOSE: With the recent increase in underwater activity, the number of people at risk for decompression sickness has greatly increased. However, an organized medical system for emergency treatment, evacuation, and hyperbaric oxygen therapy of decompression sickness has not been established yet. We collected information about domestic hyperbaric chambers available for treating decompression sickness. METHODS: We identified 95 hyperbaric chambers in hospitals, hydrospace construction corporations, military, maritime police, 119 rescue services, and other organizations through a telephone survey. We visited the 95 chambers and collected information about location, operating institutes, chamber specifications, and operational status. Twenty-four oxygen capsules were excluded from the study because of inadequate working pressure. RESULTS: Seventy-one hyperbaric chambers available for hyperbaric oxygen therapy were identified among 59 organizations. The hyperbaric chambers were distributed evenly along coastal lines; that is, 21 on the east coast, 26 on the west coast, 21 on the southern coast, and three on Jeju Island. Thirty-eight chambers with maximal working pressure of > or =5 atm could be used for severe decompression sickness and arterial gas embolism treatment. Twenty-nine chambers had a seating capacity equal to-or more than three patients. Twenty-eight chambers had two or more compartments; thus, they could handle complex medical situations. Thirty-eight chambers with medical locks were useful for severe decompression sickness treatment. CONCLUSION: A sufficient number of domestic hyperbaric chambers available for treating decompression sickness were distributed evenly along the coastal lines. However, potential barriers need to be overcome to establish an efficient decompression sickness treatment system.
Academies and Institutes ; Capsules ; Decompression ; Decompression Sickness ; Diving ; Embolism, Air ; Emergency Treatment ; Humans ; Hyperbaric Oxygenation ; Military Personnel ; Oxygen ; Police ; Republic of Korea ; Telephone

Kasabach-Merritt phenomenon does not occur with common hemangioma, rather it is associated with the more aggressive Kaposiform hemangioendothelioma and rarely with other vascular neoplasm. We report the case of an adult who was diagnosed as Kaposiform hemangioendothelioma complicated by Kasabach-Memtt phenomenon. This is the first report in Korea of an adult with Kasabach-Merritt phenomenon who has osteolytic changes of femur, pelvic bone, and lumbar spine.
Adult* ; Femur ; Hemangioendothelioma* ; Hemangioma ; Humans ; Kasabach-Merritt Syndrome ; Korea ; Pelvic Bones ; Spine ; Vascular Neoplasms

PURPOSE: The number of people who visit outpatient departments for a self-examination, health examination or an examination about breast disease has recently been increasing. Among these peoples, some of them have abnormal finding for their breasts, and several diagnostic methods are presently being used for the accurate diagnosis of these patients. In this study, we wished to increase the diagnosis rate of breast disease and we wanted to create the opportunity for obtaining accurate diagnosis by using mammography, ultrasonography and fine needle aspiration biopsy. METHODS: From January 2000 to December 2002, 127 patients among all the patients who visited department of surgery, were clinically assessed with using ultrasonography, mammography, fine needle aspiration biopsy and postoperative histopathology after they had first undergone excisional biopsy. We had calculated the sensitivity, specificity, the positive predictive value, the negative predictive value and the diagnostic accuracy of each diagnostic method. We assigned points for the diagnostic result and we then calculated the sensitivity and specificity via these points. RESULTS: The sensitivity of ultrasonography, mammography and fine needle aspiration biopsy was 94.9%, 82.1% and 94.9%, respectively, and the specificity was 62.5%, 90.9% and 93.2%, respectively. The positive predictive value was 52.9%, 80% and 86.0%, and the negative predictive value was 96.5%, 92% and 97.6%, and the diagnostic accuracy was 72.4%, 88.2% and 93.7%, respectively. We divided the results by the benign and malignant nature of the findings with using points, and on this triple test, the sensitivity was 97.4%, the specificity was 97.7%, the positive predictive value was 95%, the negative predictive value was 98.9% and the diagnostic accuracy was 97.6%. CONCLUSION: When diagnosing breast disease, the modified triple test showed that it reduce the rate of performing unnecessary surgical operations. Good skilled technique when performing fine needle aspiration biopsy can help to future reduce this rate even more.
Biopsy ; Biopsy, Fine-Needle ; Breast Diseases* ; Breast* ; Diagnosis* ; Humans ; Mammography ; Outpatients ; Self-Examination ; Sensitivity and Specificity ; Ultrasonography