Atrial fibrillation is a major cardiac cause of stroke, and a pathogenesis involving thrombus formation in patients with atrial fibrillation is well established. A strategy for rhythm control that involves catheter ablation and anticoagulation therapy is evolving. A strategy for rhythm control that restores and maintains sinus rhythm should reduce the risk of ischemic stroke that is associated with atrial fibrillation; however, this is yet to be proven in large-scale randomized controlled trials. This paper reviews the emerging role of rhythm control therapy for atrial fibrillation to prevent stroke.
Atrial Fibrillation* ; Catheter Ablation ; Humans ; Stroke* ; Thromboembolism ; Thrombosis

No abstract available.
Manganese*

No abstract available.
Animals ; Cats* ; Reflex*

No abstract available.
Female ; Pregnancy ; Pregnancy, Multiple*

Three patients with complex partial seizures had dysembryoplastic neuroepithelial tumor (DNET) in temporal lobe. In all cases, longterm video-EEG monitoring showed epileptogenic focus in left temporal lobe where small mass lesion was located. For further seizure localization and functional mapping, subdural grids were placed on left temporal lobe including lesions. Lateral temporal lobectomy with lesionectomy was performed in two cases. Lateral temporal lobe resection and amygdalohippocampectomy was done in one case. The pathological findings of all lesions were characterized by intracortical location, multiple nodular architecture, foci of dysplastic cortical disorganization and the presence of a specific glioneuronal element. All patients have been seizure free.
Epilepsy, Temporal Lobe* ; Humans ; Neoplasms, Neuroepithelial* ; Seizures ; Temporal Lobe*

OBJECTIVE: Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. METHODS: We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. RESULTS: Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs. 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. CONCLUSION: Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.
Animals ; Arthroplasty ; Convalescence ; Diskectomy ; Extremities ; Follow-Up Studies ; Humans ; Length of Stay ; Lordosis ; Neck ; Radiculopathy ; Return to Work ; Upper Extremity

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels* ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction* ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis*

Rapid-eye-movement (REM) sleep behavior (RBD) is a form of REM sleep motor dyscontrol characterized by complex, vigorous, and frequently violent behaviors without atonia during the REM sleep. The motor dyscontrol may include not only cataplexy and sleep paralysis but alto periodic limb movements during REM and non-REM sleep. We examined two patients with charateristic episodes of behavioral manifestations during the REM sleep as well as with other sleep disorders such as narcolepsy and periodic limb movement disorder. The one patina was an 18 year-old man who had childhood-onset RBD associated with narcolepsy since 10 years old. The polysomnographic studies showed excessive augmentation of chin EMG and 6 attacks of violent behavior during REM sleep. He also complained of cataplexic symptomes. Multiple sleep latency tests (MSLT) showed four sleep onset REMs and two episodes of violent behavior during the REM sleep. The other patient was a 74 year-old man who complained of violent behaviors during the REM sleep and polysomnographic studies showed excessive augmentation of chin EMG during the REM sleep and periodic leg movements for 24min. And 14sec. During the sleep. We report two patients with RBD which were associated with narcolepsy, and periodic limb movememt disorder irrespectively, suggesting that RBD, narcolepsy and periodic limb movement disorder could occur coincidently and be understood as a motor dyscontrol during REM sleep.
Adolescent ; Aged ; Cataplexy ; Child ; Chin ; Extremities ; Humans ; Leg ; Mental Disorders* ; Narcolepsy* ; Nocturnal Myoclonus Syndrome* ; REM Sleep Behavior Disorder ; Sleep Wake Disorders ; Sleep Paralysis ; Sleep, REM*

From January 1984 to June 1991, we studied testicular relapsed patients among 105 cases of acute lymphocytic leukemia in children who were admitted to the Department of Pediatrics and Yonsei Cancer Center, Yonsei University Severance Hospital. The results were as follows: 1) 15 out of 105 (14.4%) cases of acute lymphocytic leukemia were diagnosed as testicular relapse. According to the prevalence by the age groups, there were no patient under 2 years old, 14 out of 73 (19.4%) in 2~9 years old and 1 out of 26 (3.8%) over 10 years old groups. 2) At initial diagnosis of acute lymphocytic leukemia there were significant correlation between testicular relapse and initial lymphadenopathy (p=0.09), but not with WBC count, hemoglobin level, platelet count, hepatomegaly and splenomegaly. 3) Mean duration to testicular relapse from initial diagnosis of acute lymphocytic leukemia was 3.1+/-1.7 years. 4) Among 15 patients, 7 cases combined with bone marrow or central nervous system relapse. Their survival rate was lower than isolated testicular relapse groups. 5) The 5 years survival rate of testicular relapsed patients was 67% after the combinations of chemotherapy, radiotherapy and orchiectomy.
Bone Marrow ; Central Nervous System ; Child ; Child, Preschool ; Diagnosis ; Drug Therapy ; Hepatomegaly ; Humans ; Lymphatic Diseases ; Orchiectomy ; Pediatrics ; Platelet Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prevalence ; Radiotherapy ; Recurrence* ; Splenomegaly ; Survival Rate

To find out whether the commonly observed ictal behaviors in temporal lobe epilepsy (TLE) contribute to the lateralization of epileptogenic focus, 116 seizures in 19 unilateral TLE patients were reviewed and analyzed carefully by two epileptologists. Unilateral motor manifestations such as dystonia, tonic posturing, clonic jerking, head version, head turning, eye deviation, unilateral eye blinking and unilateral automatism were observed in ipsilateral or contralateral side of EEG seizure focus. Ictal language was classified as normal speech, speech arrest, dysphasia and nonidentifiable speech. They were evaluated for their significance in determining dominant (DHS) or nondominant hemisphere onset (NHS) based on the results of Wada test. Other categories of automatisms were analyzed to investigate whether they indicate right or left TLE. Dystonia(in 34 seizures), tonic posture(17), clonic jerking(24) and head version (14) were observed only in contralateral side of EEG seizure focus in 89 seizures. The direction of head turning was ipsilateral to seizure focus in 15 seizures (46.9%) and contralateral to seizure focus in 17 seizures (53.1%), Eye deviation direction inclined to suggest contralateral hemisphere seizure origin without statistical significance [contralateral in 13 seizures (65%) and ipsilateral in 7 seizures (35%)]. Unilateral eye blinking and unilateral automatism were seen in 35 seizures and occurred exclusively in ipsilateral side to ictal EEG onset (12,85.7% ;23,88.5%) compared with contralateral side(2,14.3% ;3,11.5%). Ictal normal speech was observed in 9 seizures of 2 patients who had NHS, wheares dysphasia occurred in 4 DHS of 3 patients. Deglutition, sexual automatism and sniffing were observed in both right and left TLE, and not valuable in seizure lateralization. These results show unilateral dystonia, tonic posture, clonic jerking and head version suggest strongly contralateral hemisphere seizure origin. Unilateral eye blinking and unilateral automatism indicate ipsilateral hemisphere seizure focus. Among ictal speech manifestations, ictal normal speech and dysphasia suggested NHS and DHS respectively.
Aphasia ; Automatism ; Blinking ; Deglutition ; Dystonia ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Posture ; Seizures ; Temporal Lobe*