Spontaneous anterior cerebral artery (ACA) dissection, although extremely rare, is often associated with severe morbidity and mortality. It could lead to cerebral hemorrhage, ischemic stroke, or, rarely, combination of hemorrhage and ischemia due to hemodynamic changes. Prompt and accurate diagnosis is essential for determining the appropriate management. However, the optimal treatment for ACA dissection remains controversial. Herein, we report on two rare cases of subarachnoid hemorrhage (SAH) caused by ACA dissection; a case presenting with simultaneous SAH and infarction without aneurysmal formation and another case presenting with SAH with fusiform aneurysmal formation. A review of the related literature is provided, and optimal treatments for each type of dissection are suggested.
Aneurysm* ; Anterior Cerebral Artery* ; Cerebral Hemorrhage ; Diagnosis ; Hemodynamics ; Hemorrhage* ; Infarction ; Ischemia* ; Mortality ; Stroke ; Subarachnoid Hemorrhage*

OBJECTIVE: Although burr hole trephination is a safe and effective surgical option to treat patients with chronic subdural hematoma (CSDH), it often results in a small but undesirable scalp depression from burr hole defect. This study is to evaluate the efficacy of titanium burr hole cover (BHC) for reconstruction of skull defects in these patients. METHODS: A hundred and ninety-six cases of burr hole trephinations for CSDHs between January 2009 and December 2013 were assigned into two groups; Gelfoam packing only (GPO) and reconstruction using titanium BHC group, according to the modalities of burr hole reconstructions. The incidences and depths of scalp depressions and incidences of postoperative complications such as infections or instrument failures were analyzed in both groups. We also conducted telephone surveys to evaluate the cosmetic and functional outcomes from patient's aspect. RESULTS: Significantly lower incidence (p<0.0001) and smaller mean depth (p<0.0001) of scalp depressions were observed in BHC than GPO group. No statistical differences were seen in postoperative infection rates (p=0.498) between the two groups. There were no instrument failures in BHC group. According to the telephone surveys, 73.9% of respondents with scalp depressions had cosmetic inferiority complexes and 62.3% experienced functional handicaps during activities of daily life. CONCLUSION: Titanium BHC is highly effective for reconstruction of skull defect after burr hole trephination of CSDH, and provides excellent cosmetic and functional outcomes without significant complications.
Surveys and Questionnaires ; Depression ; Gelatin Sponge, Absorbable ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Postoperative Complications ; Scalp ; Skull* ; Telephone ; Titanium* ; Treatment Outcome ; Trephining*

Dieulafoy's lesion is a relatively uncommon disease which is minor cause of massive acute lower gastrointestinal bleeding. The lesion comprises mainly of an abnormally exposed submucosal artery associated with a minute mucosal defect on the top in the stomach, and it is a rare cause of profuse but intermittent gastrointestinal bleeding. Less commonly, similar lesions have also been identified in the duodenum, jejunum, colon, and in rare cases, the rectum. In this report, 70 year-old man is described, who has an massive hematochezia from a small rectal mucosal defect with an exposed vessel. Control of the bleeding was successfully achieved with endoscopic band ligation. The fact that rectal Dieulafoy's disease is rare but one of the causes of massive hematochezia should serve as a reminder in the future cases in the elderly.
Aged ; Arteries ; Colon ; Duodenum ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Jejunum ; Ligation* ; Rectum ; Stomach

We present a case of two siblings with different chromosome 21 abnormalities that are both de novo [r (21) /i (21p13) mosaicism and rob (14; 21) ]. Molecular studies using polymorphic markers have shown that these two aberrations had a common maternal origin. However, the parents were cytogenetically and phenotypically normal. This unusual association has not been reported and is considered to be a unique case that should be addressed.
Child ; *Chromosome Aberrations ; *Chromosomes, Human, Pair 21 ; Cytogenetic Analysis ; *Down Syndrome ; Female ; *Gene Deletion ; Humans ; Karyotyping ; Mental Retardation/genetics ; Mosaicism ; Mothers ; Parents ; *Siblings

OBJECTIVE: To know the clinical and histopathologic profiles of ovarian tumors. METHODS: 822 women undergone operations for their ovarian tumors were enrolled in this study from July of 1996 to June of 2004 at Inha University Hospital in S. Korea. Incidence, age, laterality and size were analyzed according to their histopathologic results. RESULTS: Among 822 women, there were 2.1% of non-neoplastic ovarian cysts, 81.0% of benign tumors, 4.4% of borderline tumors, and 12.5% of malignant tumors. Among benign tumors, 48.2 were cystic teratomas, 22.5% were mucinous, and 19.4% were serous tumors. Among borderline tumors, 52.8% were mucinous and 42.2% were serous. Among malignant tumors, 25.2% were serous and metastatic, respectively, and 18.4% were mucinous. The average and median age of non-neoplastic cysts were 39.1 +/- 12.7, 41 years old, those of benign tumors were 38.2 +/- 18.4, those of borderline tumors were 33.4 +/- 16.7, 28, and those of malignant tumors were 47.8 +/- 15.4, 49. The bilaterality of benign tumors was 10.7%, that of borderline were 16.7%, and that of malignant were 24.2%. The average and median diameter of non-neoplastic cysts were 3.2 +/- 1.4 cm, 3 cm, those of benign tumors were 8.1 +/- 4.3 cm, 7 cm, those of borderline tumors were 13.5 +/- 7.8 cm, 12 cm, and those of malignant tumors were 10.2 +/- 6.1 cm, 9.3 cm. CONCLUSION: We analyzed clinical and histopathologic data of 822 ovarian tumors.
Adult ; Female ; Humans ; Incidence ; Korea ; Mucins ; Ovarian Cysts ; Ovarian Neoplasms ; Teratoma

PURPOSE: We performed this study to evaluate the value as early markers predicting the acute rejection and differential diagnosis with other causes of renal dysfunction. METHODS: Immunohistochemical stains for HLA-DR, ICAM-1, IL-2 and IL-4 were performed on 44 cases of implantation biopsies which were divided into cases with acute rejection (R group, 14 cases) and cases without rejection episode (N group, 30 cases), and 45 gun biopsies for renal dysfunction which divided into cases diagnosed as rejection (A group, 28 cases) and cases diagnosed as other causes rather than rejection (B group, 17 cases). We analysed immunohistochemical results, various clinical datas such as age and sex of donor, living or cadaveric status of donor, the mean number of HLA-DR mismatch, age and sex of patient, serum creatinine level at post op 2 day for implantation biopsy and at the day on biopsy for renal dysfunction between above groups. RESULTS: 1) In 44 cases of implantation biopsies, positive immunohistochemical stains for HLA-DR were more frequent in R goup (71.43%) than in N group (26.66%). There was no significant difference of clinical datas and immunohistochemical stains for ICAM-1, IL-2 and IL-4. 2) In 45 cases of gun biopsies for renal dysfunction, immunohistochemical stains for HLA-DR were all positive in A group (100%) with higher rate of 3 stains (39.28%) than B group (positive; 70.58%, 3 ; 5.88%). Immunohistochmical stains for ICAM-1 were more frequently expressed in A group (100%) than B group (76.47%). Both stains revealed no significant difference according to the grades of rejection, disease other than rejection. There was no significant diffrence of immunohistochemical stains for IL-2 and IL-4, and clinical datas between two groups. CONCLUSION: We can conclude that the immunohistochemical stains for HLA-DR on implantation biopsies may predict the devepoment of the acute rejection and the immunohistochemical stains for HLA-DR and ICAM-1 on gun biopsies at the time of renal dysfunction may differentiate the reje.
Biopsy* ; Cadaver ; Coloring Agents ; Creatinine ; Diagnosis, Differential ; HLA-DR Antigens* ; Humans ; Intercellular Adhesion Molecule-1* ; Interleukin-2* ; Interleukin-4* ; Kidney Transplantation ; Living Donors ; Tissue Donors

OBJECTIVES: This study analyzes the effect of electroconvulsive therapy (ECT) by predicting the factors contributing to the effectiveness of ECT and evaluating the persistency of ECT effect in patients with treatment-resistant schizophrenia. METHODS: Using retrospective review of the charts of 24 schizophrenic inpatients who were admitted to Busan Paik Hospital between March 1, 2005 and December 31, 2009. We compared the pre-ECT Clinical Global Impression (CGI) scores and post-ECT CGI scores among these patients. We evaluated the differences in the ECT responses by sex, age, duration of illness and dose of antipsychotic agents, and investigated the rate of continuation of out-patient treatment and readmission, and the change of the CGI score for 12 months after the ECT. RESULTS: ECT resulted in an overall clinical improvement as measured on the CGI scale. 15 (62.50%) patients were good responders, while 9 (37.50%) were poor responders. There was no significant difference between sex, age, duration of the illness, and dose of antipsychotics taken by the patient before the ECT. 21 (87.50%) patients continuously visited the outpatient department for 12 month, and 14 (66.67%) of them maintained the ECT effect with medical treatment only and without readmission. CONCLUSION: This study showed that the ECT could be a useful treatment option for schizophrenic patients who are resistant to antipsychotics.
Antipsychotic Agents ; Electroconvulsive Therapy ; Humans ; Inpatients ; Outpatients ; Retrospective Studies ; Schizophrenia

BACKGROUND/AIMS: The adoption of colonoscopy as a primary colorectal cancer (CRC) screening technique has been argued for in Korea, without evidence of patient preferences. This study aimed to investigate patients’ preferences for the primary CRC screening test for the National Cancer Screening Program (NCSP). METHODS: Between June and August 2016, 414 individuals aged ≥50 years who participated in the NCSP were prospectively invited to complete a questionnaire regarding their preferences for the primary CRC screening test and the reasons for their selection. RESULTS: Among the 396 respondents who completed the questionnaire, 124 individuals (31.3%) preferred the fecal immunochemical test (FIT), whereas 272 individuals (68.7%) preferred colonoscopy. Elderly participants preferred the FIT (p < 0.001), whereas participants with a higher education level (p=0.030), a higher income level (p=0.009), or individuals with a family member (p=0.028) or acquaintance (p=0.013) with a history of CRC preferred colonoscopy. Only 12.9% of participants had a bad experience with a previous FIT; however, 39.3% of participants had a bad experience with a previous colonoscopy. CONCLUSIONS: Colonoscopy was preferred to FIT in a 2.2:1 ratio as the primary CRC screening test for the NCSP. Patients’ preference for colonoscopy should be considered for the NCSP in Korea.
Aged ; Colonoscopy ; Colorectal Neoplasms* ; Early Detection of Cancer ; Education ; Humans ; Korea* ; Mass Screening* ; Patient Preference ; Prospective Studies ; Surveys and Questionnaires

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.
Colonoscopy ; Colorectal Neoplasms ; Consensus ; Early Detection of Cancer* ; Early Diagnosis ; Endoscopy* ; Endoscopy, Gastrointestinal ; Expert Testimony ; Gastroscopy ; Korea* ; Mass Screening ; Outcome Assessment (Health Care) ; Quality Improvement* ; Stomach

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.
Colonoscopy ; Colorectal Neoplasms ; Consensus ; Early Detection of Cancer* ; Early Diagnosis ; Endoscopy* ; Endoscopy, Gastrointestinal ; Expert Testimony ; Gastroscopy ; Korea* ; Mass Screening ; Outcome Assessment (Health Care) ; Quality Improvement* ; Stomach