No abstract available.
Humans ; Magnetic Resonance Imaging, Cine* ; Spinal Cord Diseases*

Malignant germ cell tumore occur in children and young women in reproductive age, of all the germ cell maligaanci orily pure dysgerminiomas had a high cure rate prior to 1970. This was due to the exquisite wdioseneitivity of these tumors. Multiple agent chemotherapy has dramatieally improved the pr nosis af patients with malignant ovarian germ cell tumors. The purpose of this study is to report the experience at Aaan Medical Center, department of Obstetrics and Gynecology, in 16 patients withmalignant ovarian germ cell tumors treated between July, l989 and June, l994. We analyzed the effect of age, histolagic subtype, FIGO stage, surgical pmcedurse and regimens of chemotherapy, on the prognosis of thwe tumors. The results obtained were as follows: 1. In histologic subtypes, dysgenninoma(38.0%), endodermal sinus tumor(25.0%), squamous cell carcinoma arising in mature cystic teratoma(19.0%), mixed cell tumor(6.0%), immature teratoma(6.0%), malignant ectodermal tumor in mature cystic teratoma(6.0%), were counted in order. 2. No site predilection was identifed. 3. Main initial symptoms were abdominal distension(31.0%), abdominal pain(31.0%), abdominal mass palpation(25.0%), amenorrhea(6.0%) in order. 4. Multiple tumor markers were considered to be useful in diagnosis and follow up of malignant germ cell tumors of ovary. 5. The mean age of malignant ovarian germ cell tumors was 29.5 years, and 11 cases(69.3%) of tumors under the age of 30.0 years. 6. The survival rate seemed to be decreased with advancing FIGO stage.
Carcinoma, Squamous Cell ; Child ; Diagnosis ; Drug Therapy ; Ectoderm ; Endoderm ; Female ; Follow-Up Studies ; Germ Cells* ; Gynecology ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Obstetrics ; Ovary* ; Prognosis ; Survival Rate ; Biomarkers, Tumor

OBJECTIVES: The aim of this study was to investigate mortality rates and risk factors in dementia patients in a rural cohort. METHODS: A total of 114 subjects with clinically diagnosed dementia were followed up for eight years from 1997 to 2005. Their mortality was compared with sociodemographic and clinical variables using the Cox proportional hazards models after adjusting age, sex, and education. RESULTS: During follow-up, the mortality rate of subjects was 80.2% and the mean (SD) duration of survival from at diagnosis to death was 4 years. Mortality in subjects with dementia depended on old age (relative risk [RR] : 1.05 ; 95% confidence interval [CI] : 1.01-1.08), male (RR : 1.61 ; CI : 1.00-2.59), low Clinical Dementia Rating scale (RR : 1.54 ; CI : 1.14-2.10), low Activities of Daily Living (RR : 0.72 ; CI : 0.59-0.89), low Instrumental Activities of Daily Living (RR : 0.83 ; CI : 0.75-0.92), no physical activity (RR : 0.44 ; CI : 0.28-0.70), smoking (RR : 1.74 ; CI : 1.05-2.89). CONCLUSION: Mortality in dementia depended on age, sex, CDR, ADL, IADL, physical activity, smoking. These findings have important implications that contribute to make the disease management of dementia patients.
Activities of Daily Living ; Cohort Studies ; Dementia* ; Diagnosis ; Disease Management ; Education ; Follow-Up Studies ; Humans ; Male ; Mortality* ; Motor Activity ; Proportional Hazards Models ; Risk Factors* ; Smoke ; Smoking

No abstract available.
Smoking* ; Tobacco Products*

To investigate the change in upper eyelid position after cataract operation, We studied 40 eyes of 40 patients prospectively who underwent phacoemulsification and intraocular lens implantation. Levator function and vertical palpebral lid fissure height were measured preoperatively and at postoperative day 1, 7, 28 and 56 in and the surgical and the fellow eyes. Postoperative mean vertical lid fissure height decreased compared with preoperative mean vertical lid fissure height in both eyes. The postoperative decrease in vertical lid fissure height tended to decrease with times and these trends had statistically significant correlation between both eyes. This suggests that both eyes are affected by factors unassociated with the cataract surgery and it is most apparent in the immediate postoperative period. In conclusion, we recommend not only the surgical eye but the fellow eye should be evaluated preoperatively and postoperatively to understand the eyelid position after cataract operation.
Cataract* ; Eyelids ; Humans ; Lens Implantation, Intraocular ; Phacoemulsification ; Postoperative Period ; Prospective Studies

OBJECTIVE: Meige syndrome is the combination of blepharospasm and oromandibular dystonia. We assessed the surgical results of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) in patients with medically refractory Meige syndrome. METHODS: Eleven patients were retrospectively analyzed with follow-ups of more than 12 months. The mean follow-up period was 23.1 +/- 6.4 months. The mean age at time of surgery was 58.0 +/- 7.8 years. The mean duration of symptoms was 8.7 +/- 7.6 years. DBS electrodes were placed under local anesthesia using microelectrode recording and stimulation. After 2.4 +/- 1.3 days of trial tests, the stimulation device was implanted under general anesthesia. Patients were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). RESULTS: BFMDRS total movement scores improved by 59.8%, 63.5%, 74.1%, 74.5%, and 85.5% during the immediate postoperative period of test stimulation, 3, 6, 12, and 24 months (n = 5) after surgery, respectively. The BFMDRS total movement scores were reduced gradually and the results reached statistical significance in the postoperative period (test period, p < 0.001; 3 months, p < 0.001; 6 months, p = 0.003; 12 months, p < 0.001; 24 months, p = 0.042). There was no statistical difference between 12 months and 24 months. BFM subscores improved by 63.3% for the eyes, 80.9% for the mouth, 68.4% for speech/swallowing, and 87.9% for the neck at 12 months after surgery. The adverse effects were insignificant. CONCLUSION: The bilateral GPi-DBS can be effective for the treatment of intractable Meige syndrome without significant side effects.
Anesthesia, General ; Anesthesia, Local ; Blepharospasm ; Deep Brain Stimulation ; Dystonia ; Electrodes ; Eye ; Follow-Up Studies ; Globus Pallidus ; Humans ; Meige Syndrome ; Microelectrodes ; Mouth ; Neck ; Postoperative Period ; Retrospective Studies

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.
Accidental Falls ; Analgesia ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Early Ambulation ; Femoral Nerve ; Humans ; Knee ; Nerve Block ; Pain Management ; Peripheral Nerves ; Postoperative Complications ; Quadriceps Muscle ; Rehabilitation

OBJECTIVE: Strategies for managing supratentorial primitive neuroectodermal tumors(PNETs) in children include surgical resection, craniospinal irradiation and chemotherapy. This study is performed in order to compare the efficacy of various methods of treatment and to describe its optimal management. METHODS: We have reviewed all medical records and pathology slides of six children(four males and two females) with supratentorial PNET from November, 1987 to May, 2003. The extent of resection was confirmed by computed tomography and magnetic resonance studies. RESULTS: The patients were aged 1 to 13 years and treated postoperatively with/without adjuvant therapy. Tumor location included was four cortical, one gangliobasal, and one pineal region. The presenting symptoms and signs consisted of increased intracranial pressure and focal neurological deficits such as seizure and hemiparesis. The treatment consisted of surgical resection alone in one patient, postoperative radiotherapy in one patient, postoperative chemotherapy in one, and postoperative radiotherapy with chemotherapy in three. Five patients lived more than 12 months after diagnosis and one patient among them has been living more than 5 years after diagnosis. CONCLUSION: We can improve the survival and prognosis of supratentorial PNET patients by radical gross total resection of tumor followed by craniospinal irradiation and aggressive chemotherapy. First of all, gross total resection of tumor is the most important among many factors.
Child* ; Craniospinal Irradiation ; Diagnosis ; Drug Therapy ; Humans ; Intracranial Pressure ; Male ; Medical Records ; Neural Plate ; Neuroectodermal Tumors, Primitive* ; Paresis ; Pathology ; Prognosis ; Radiotherapy ; Seizures

BACKGROUND AND SIGNIFICANCE: Parkinsoinsm is characterized by clinical symptoms of igidity, bradykinesia, tremor, and gait disturbance. There are many causes of secondary parkinsonism. Hypocalcemia associated with hypoparathyrodism is a rare metabolic cause of secondary parkinsonism. We experienced a case presenting reversible secondary parkinsonism caused by hypocalcemia associated with idiopathic hypoparathyroidism. CASE: A 35-year-old woman was admitted to our hospital because of generalized edema. She had been diagnosed as nephrotic syndrome for 1 year. During admission, slurred speech suddenly developed and hypocalcemia was founded. With replacement of calcium and dialysis, these symptom were improving. However, she complained of slowly progressive gait disturbance. On examination, she had parkinsonian features including masked face, slurred speech, rigidity of all extremities, bradykinesia, gait disturbance with short step, and stooped posture. Laboratory studies showed hypocalcemia, primary hypoparathyroidism, normal thyroid and parathyroid scan. Brain CT and MRI revealed normal. She was diagnosed as secondary parkinsonism following hypocalcemia associated with idiopathic hypoparathyroidism. She was started on levodopa and bromocriptine, and parkinsonian features slowly improved. One month later, she was fully recovered from parkinsonian features, and then levodopa and bromocriptine were discontinued. COMMENT: We report a case of reversible secondary parkinsonism caused by hypocalcemia with idiopathic hypoparathyroidism.
Adult ; Brain ; Bromocriptine ; Calcium ; Dialysis ; Edema ; Extremities ; Female ; Gait ; Humans ; Hypocalcemia ; Hypokinesia ; Hypoparathyroidism* ; Levodopa ; Magnetic Resonance Imaging ; Masks ; Nephrotic Syndrome ; Parkinson Disease, Secondary ; Parkinsonian Disorders* ; Posture ; Thyroid Gland ; Tremor

BACKGROUND AND PURPOSE: Hemifacial spasm(HFS) is a chronic and often progressive disorder characterized by unilateral irregular clonic and tonic contractions of one or more muscles of facial expression. Many previous electrophysiologic studies showed characteristic features of HFS differentiating from other involuntary movements of the face. However, there has been no electrophysiologic study for estimating the clinical severity of HFS. This study was prospectively designed to evaluate the relationships between electrophysiologic findings and clinical severity of HFS. METHODS: The authors performed direct facial nerve stimulation, blink reflex, and lateral spread response in 62 patients with HFS, and compared the results of affected side with those of unaffected each other. Clinical severity was graded into seven groups (0-6) by questionnaire and confirmed by a neurologist. RESULTS: The results were as following. 1) The total number of subjects were 62, the number of patients in group 2 was 3 (4.8%), group 3 was 12 (19.3%), group 4 was 25 (40.3%), group 5 was 21 (33.9%), and group 6 was 1(1.6%). 2) The mean age was 54.5+/-9.1years old, the mean duration of the illness was 6.4+/-4.9years, male was 11(17.7%) and female was 51(82.3%), and involved sites were right in 26(41.9%) and left in 36(58.1%) patients. 3) Direct stimulation of facial nerve showed no differences between affected and unaffected sides in HFS. 4) The results of blink reflex showed more increased latencies and larger amplitudes of R1 & R2 responses in affected sides than in unaffected sides of HFS, but no differences among the groups. 5) The lateral spread responses were found in 45 of 62 (72.6%) patients by stimulation of zygomatic branch and recording in mentalis muscle, 26 of 62 (41.9%) patients by stimulation of mandibular branch and recording in orbicularis oculi muscle on affected side. 6) There was a linear correlation between the presence of lateral spread response with zygomatic or mandibular stimulation and the grade of clinical severity. CONCLUSION: We suspected that the lateral spread response was a significant electrophysiological test for estimating the clinical severity of HFS.
Blinking ; Dyskinesias ; Facial Expression ; Facial Nerve ; Female ; Hemifacial Spasm* ; Humans ; Male ; Muscles ; Prospective Studies ; Surveys and Questionnaires