BACKGROUNDS: The inflammatory reaction after cerebral ischemia involving adhesion molecules aggravates neurologic deficit. This study aimed to study the change of plasma level of the adhesion molecules after acute cerebral ischemia. METHODS: Nineteen patients with acute cerebral infarction and ten control subjects without a history of cerebrovascular disease were included in this study. The patient groups were subgrouped into large artery atherosclerosis and small artery occlusion groups according to TOAST classification. Plasma levels of sP-selectin, sE-selectin, sICAM-1 and sVCAM-1 were measured within 24 hours and in 6 to 8 days after acute ischemic infarction. RESULTS: The plasma level of sP-selectin was elevated in acute stroke patients within 24 hours and in 6 to 8 days after stroke onset compared with control group(p<0.05). But plasma levels of sE-selectin, sICAM-1 and sVCAM-1 were not different from those of control group. The plasma level of sP-selectin was significantly elevated in large artery artherosclerosis group compared with control group. CONCLUSION: This study suggest that P-selectin actively involves in inflammatory process after acute ischemic stroke, especially associated with atherosclerosis.
Arteries ; Atherosclerosis ; Brain Ischemia ; Cerebral Infarction ; Classification ; Humans ; Infarction ; Neurologic Manifestations ; P-Selectin ; Plasma* ; Stroke*

CHAP syndorme consists of choreoathetosis, orofacial dyskinesia, affective change, hypotonia, and pseudobulbar signs. CHAP syndrome was firstly des- cribed with onset 1 to 7 days after induced profound hypothermia and complete circulatory arrest for con- genital heart lesion repair. Since then, only a few cases have been reported until now. Case We report a patient who demonstrated all of the elements of the CHAP syndrome in severe cachexic state. Brain SPECT(99mTC-ECD) shows decreased perfusion in left fronto-parieto-temporal lobe. Comments The pathogenesis of CHAP syndrome is obscure. However our case led us to suggest that more essential component pre- disposing to the CHAP syndrome is hypoxia rather than hypothermia. Furthermore, it seems to be related with circulatory insufficiency in extrapyramidal nervous systems.
Anoxia ; Brain ; Heart ; Humans ; Hypothermia ; Movement Disorders ; Muscle Hypotonia ; Nervous System ; Perfusion

We would like to correct the affiliation for the first author.

No abstract available.

PURPOSE: To evaluate the effect of heat wave on emergency department (ED) visits due to heat related illness, we developed an ED based active surveillance system. We want to identify epidemiology of ED visits due to heat related illness and determine the effect of heat index on daily ED visits due to heat related illness. METHODS: We developed an ED based active surveillance system for adults who visited the ED due to heat stroke, heat exhaustion, heat syncope, heat edema, and heat cramp. We collected demographic and clinical variables, risk factors, and heat index by standardized registry on the webpage. We operated the surveillance into 16 emergency departments in Daegu City from June to September 2011. We analyzed epidemiologic variables descriptively and assessed the effect of heat index on the number of daily ED visits by multivariate Poisson regression analysis. RESULTS: During the study period, 34 cases were registered and nine cases were heat stroke. Heat stroke patients were older, and had more unemployment status than those with other heat related illness (p<0.05). More ED visits due to heat related illness were observed during the danger period than during the cool period, classified by heat index severity (Adjusted odds ratio: 1.72, 95% CI: 1.33-2.23). Increasing heat index by one degree caused more ED visits due to heat related illness (Adjusted incident rate ratio: 1.13, 95% CI: 1.07-1.19). CONCLUSION: We developed an ED based active surveillance system and observed more elderly persons and lower educational level in patients with heat stroke. In addition, increase in heat index significantly affected more daily ED visits due to heat related illness.
Adult ; Aged ; Daegu ; Edema ; Emergency Service, Hospital* ; Epidemiology ; Extreme Heat ; Heat Exhaustion ; Heat Stress Disorders ; Heat Stroke ; Hot Temperature* ; Humans ; Infrared Rays ; Odds Ratio ; Public Health Surveillance ; Risk Factors ; Syncope ; Unemployment

PURPOSE: The solid variety of cerebella r tumors in adult is relatively uncommon. This study is to describe the characteristic MR findings of various solid cerebellar tumors in adult. METHODS: Twenty three cerebellar solid tumors from 22 consecutive patients over age of 15 with surgical confirmations were retrospectively evaluated with MR imaging. H istologic diagnosis included hemangioblastoma (n=6), metastasis (n=6), high-grade astrocytoma (n=3), and medulloblastoma (n=8). The MR findings were reviewed with attention to the size, the signal intensity of the tumors, pattern of enhancement, tumoral margin, degree of peritumoral edema, signal void vascular structures within and/or around the tumor, and location in relation to attachment to the pial surface of the tumor. RESULTS: Solid hemangioblastomas consistently showed slightly low or iso signal intensity on T1 -weighted images and high intensity on T2-weighted images, dense homogeneous enhancement, and signal void vessels within and/or around the mass. Metastatic tumors showed various find ings with predominantly low or iso signal intensity on T2-weighted images. Medulloblastomas was midline and/or paramidline in location, and had larger mass formation. High-grade astrocytomas revealed nonspecific MR findings with no signal void vessels. CONCLUSION: Hemangioblastoma, metastasis, malignant astrocytoma, and medulloblastoma should be included in differential diagnosis of solid cerebellar tumors in adult. Dense homogeneous enhancement and signal void vessels are characteristic of hemangioblastoma. The signal intensity of the tumor, and presence of signal void vessels, location and enhancement pattern can be some value in differential diagnosis of solid cerebellar tumors in adult.
Adult* ; Astrocytoma ; Cerebellar Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Edema ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Neoplasm Metastasis ; Retrospective Studies

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.
Adult ; Arteriovenous Malformations* ; Brain ; Cerebral Angiography ; Drainage ; Headache ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Perfusion ; Tomography, Emission-Computed, Single-Photon ; Veins ; Visual Fields*

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.
Adult ; Arteriovenous Malformations* ; Brain ; Cerebral Angiography ; Drainage ; Headache ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Perfusion ; Tomography, Emission-Computed, Single-Photon ; Veins ; Visual Fields*

OBJECTIVE: The aim of this study is to evaluate the clinical usefulness of cervicogram as primary screening test of cervical intraepithelial neoplasia. METHODS: Total 294 women who had undergone cervicogram and pathologically diagnosed at YUMC between January and July 2003, were selected. Diagnostic accuracy of Pap smear, cervicogram and Pap smear combined with cervicogram were compared with pathologic diagnosis. Statistical analysis was performed by chi-square test (SPSS version 11.0). RESULTS: 1. Among 294 women, Pap smears were normal in 130 cases (44.2%) and abnormal in 164 cases (55.8%). The diagnostic accuracy between Pap smear and histology was as follows; sensitivity 72.0%, specificity 64.6%, positive predictive value 72.0%, negative predictive value 64.6%, false positive rate 28.0%, false negative rate 35.4%. 2. Cervicogram were normal in 202 cases (68.7%) and abnormal in 92 cases (31.3%). The diagnostic accuracy between cervicogram and histology was as follows; sensitivity 39.6%, specificity 79.2%, positive predictive value 70.7%, negative predictive value 31.0%, false positive rate 29.3%, false negative rate 49.0%. 3. Among 130 women with normal Pap smear, cervicogram were normal in 101 cases (77.7%) and abnormal in 29 cases (22.3%). The diagnostic accuracy between cervicogram with normal Pap smear and histology was as follows; sensitivity 26.1%, specificity 79.8%, positive predictive value 41.4%, negative predictive value 66.3%, false positive rate 58.6%, false negative rate 33.7%. 4. Among 164 women with abnormal Pap smear, Cervicograms were normal in 101 cases (61.6%) and abnormal in 63 cases (38.4%). The diagnostic accuracy between cervicogram with abnormal Pap smear and histology was as follows; sensitivity 44.9%, specificity 78.3%, positive predictive value 84.1%, negative predictive value 32.7%, false positive rate 15.9%, false negative rate 67.3%. CONCLUSION: Although adjunctive use of cervicogram to Pap smear in initial screening of cervical intraepithelial neoplasia showed higher specificity, higher negative predictive value and lower false negative rate compared to Pap smear alone, but, consideration in terms of lower sensitivity, lower positive predictive value, higher false positive rate and cost-effectiveness should be given in lieu of clinically applicating cervicogram with Pap smear as initial screening test.
Cervical Intraepithelial Neoplasia* ; Diagnosis ; Female ; Humans ; Mass Screening* ; Sensitivity and Specificity

Objectives: ：Childhood/adolescent-onset of bipolar disorder presents functional impairments on emotional, academic, and social aspects. These impairments could continue into adulthood. However, there are few studies comparing cognitive function between childhood/adolescent- and adult-onset using psychological test. This study aims to improve understanding of childhood/adolescent-onset of bipolar disorder by comparing differences in cognitive function, clinical and demographic features between the two groups. Methods: ：This study was conducted on 145 patients diagnosed with bipolar disorder type I, II, and other specified bipolar disorder by DSM 5 at the time of discharge from 2016 to 2019 at the Department of Psychiatry, Pusan National University Yangsan Hospital. Demographic information, clinical data, and results of psychological tests (K-WISC-IV, K-WAIS-IV) were collected and reviewed. Results: ：Childhood/adolescent-onset group was significantly low in total potential IQ and in language understanding than adult-onset group (p=0.008 and p=0.013). The childhood/adolescent group had significantly more psychiatric comorbidities than the adult group (p<0.001). The average number of prescribed antipsychotic agents was 1.18 (SD= ±0.64) in the childhood/adolescent group, and 1.78 (SD=±0.82) in the adult group. The difference was statistically significant (p<0.001). Conclusion ：Patients with childhood/adolescent-onset bipolar disorder have lower total potential IQ and language understanding comparing patients with adult-onset bipolar disorder. This highlights the importance of conducting a well-designed prospective study to find out more about the characteristics of childhood/adolescent-onset bipolar disorder.