The aim of this study was to investigate behavioral and psychological symptoms of dementia (BPSD) measured by caregiver-administered neuropsychiatric inventory (CGA-NPI) as a function of dementia severity in early onset (EOAD) versus late onset Alzheimer's disease (LOAD). A total of 113 patients with AD consisting of 49 patients with EOAD and 64 patients with LOAD were enrolled consecutively. General cognitive function and severity of dementia were assessed by the Korean version of mini-mental status examination and clinical dementia rating (CDR), respectively. In the mild stage (CDR 0.5-1), LOAD patients had a significantly higher total CGA-NPI score than EOAD patients. Subgroup analysis demonstrated that disinhibition and night-time behavior were more common and severe in the LOAD group than the EOAD group. However, in the moderate to severe stage (CDR 2-3), EOAD patients had a significantly higher total CGA-NPI score with higher subscores in hallucination, agitation/aggression, irritability/lability, aberrant motor behavior, and appetite/eating change. This study suggested that the heterogeneity of BPSD in AD might be accounted for by dementia severity as well as age at symptoms onset.
Alzheimer Disease* ; Dementia* ; Hallucinations ; Humans ; Population Characteristics

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

BACKGROUND AND PURPOSE: The advances in the diagnosis and treatment of acute stroke increase the importance of providing these patients with timely medical attention. This study was designed to assess time delays in neurological evaluation and neuroimaging and to determine whether they are important obstacles to performing thrombolytic therapy. METHODS: Data were obtained between May 2004 and September 2006 from 195 consecutive patients who were admitted to Cheju National University Hospital for acute ischemic stroke within 24 hours of the onset of symptoms. We determined the time of the onset of symptoms, arrival time at the emergency department (ED), and times of neurology notification, neurology evaluation, and neuroimaging using interviews and by reviewing the medical record. RESULTS: Short onset-to-door time, performing computed tomography rather than magnetic resonance imaging, presence of aphasia or motor weakness, and severe initial neurological deficit were significantly associated with reduced in-hospital delays. Seventeen (20%) of the 85 patients who arrived within 3 hours of the onset of symptoms received intravenous thrombolysis. Mild neurological deficit, rapidly improving symptoms, and insufficient time to workup were the main causes of the nonreceipt of thrombolytic therapy in these patients. Only one patient did not receive thrombolytic therapy due to delay in neurology consultation. CONCLUSIONS: Whilst in-hospital delays were not major obstacles to performing thrombolytic therapy in this study, there is still a high probability of missing patients with mild-to-moderate stroke symptoms. More effective in-hospital organization is required for the prompt evaluation and treatment of patients with acute ischemic stroke.
Aphasia ; Cerebrovascular Disorders ; Diagnosis ; Emergency Service, Hospital ; Humans ; Jeju-do ; Magnetic Resonance Imaging ; Medical Records ; Neuroimaging ; Neurology ; Stroke* ; Thrombolytic Therapy* ; Time Factors

PURPOSE: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.
Adjuvants, Anesthesia/*administration & dosage/pharmacology ; Adult ; Aged ; Antiemetics/*administration & dosage/pharmacology ; Female ; Gastrointestinal Motility/*drug effects/physiology ; Humans ; Injections, Intravenous ; Intestinal Pseudo-Obstruction/drug therapy/epidemiology/*prevention & control ; Lumbar Vertebrae/radiography/*surgery ; Male ; Metoclopramide/*administration & dosage/pharmacology ; Middle Aged ; Postoperative Complications/epidemiology ; Prevalence ; Prone Position ; Prospective Studies ; Republic of Korea ; Scopolamine Hydrobromide/*administration & dosage/*pharmacology ; Spinal Fusion/*adverse effects ; Supine Position ; Treatment Outcome

rpoB, which encodes the B subunit of RNA polymerase, is related to rifampin resistance of Mycobacterium tuberculosis and Escherichia coli. We determined the nucleotide sequences (346 bp) of rpoB gene from 25 Korean isolates of Helicobacter pylori. These nucleotide sequences were aligned and compared with H. pylori 26695 strain. No insertions or deletions were observed in all H. pylori strains. In the phylogenetic tree constructed by UPGMA method, 26 strains of H. pylori were separated into four clusters. Deduced amino acid sequences of amplified rpoB DNA comprised 115 amino acid residues. Twenty six H. pylori strains could be divided into 5 groups by the signature amino acid sequences. Two strains isolated from the same patient showed different nucleotide sequences. These results suggest that the sequences of rpoB are also highly divergent in H. pylori isolates and are useful for the epidemiologic study.
Amino Acid Sequence ; Base Sequence ; DNA ; DNA-Directed RNA Polymerases ; Escherichia coli ; Helicobacter pylori* ; Helicobacter* ; Humans ; Mycobacterium tuberculosis ; Rifampin

OBJECTIVE: The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist. METHODS: In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis. RESULTS: Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist. CONCLUSION: The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.
Axis, Cervical Vertebra ; Humans ; Medical Records ; Neurosurgery ; Spine ; Weights and Measures

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury

PURPOSE: We performed transtibial single and double bundle reconstruction of the posterior cruciate ligament using the allo-achilles tendon and compared the results of single bundle reconstruction and double bundle reconstruction both clinically and radiologically. MATERIALS AND METHODS: This study included 41 cases of posterior cruciate ligament reconstruction between February 2000 and June 2007 that had data available for at least 2 years of follow-up. Twenty-two cases (53.7%) underwent single bundle reconstruction and 19 cases (46.3%) underwent double bundle reconstruction. Clinical results were analyzed by Lysholm score and IKDC standards scale, and the radiologic results were analyzed by the Telos(R) posterior translation test. RESULTS: The average Lysholm score at last follow-up was 85.4+/-4.7 in the single bundle group and 87.5+/-5.1 in the double bundle group. IKDC scores were grade A in 4 (18.2%), grade B in 14 (63.6%) and grade C in 4 (18.2%) in the single bundle group; they were 1 (15.3%), 15 (78.9%) and 3 (15.8%) in the double bundle group. Telos(R) posterior translation test scores were 5.06 mm (3.04-7.43 mm) in the single bundle group, and 4.04 mm (2.18-7.20 mm) in the double bundle group. There was significant improvement in clinical and radiological scores in both groups (p<0.001). However, these differences were not statistically significant (p>0.05). CONCLUSION: Further study with longer term follow-up is needed.
Follow-Up Studies ; Posterior Cruciate Ligament ; Tendons

BACKGROUND AND OBJECTIVES: Diagnosis of nasal bone fracture is important because of not only deformity of the external nose but also because of other additional injuries around the nose. The purpose of this study is to explore the incidence, type, location and direction of nasal septal fracture in nasal bone fracture patients who were diagnosed by nasal bone CT. SUBJECTS AND METHOD: We analysed the medical records and films of 135 nasal bone fracture patients who were diagnosed by computerized tomography from January 2005 to September 2005. The nasal bone fracture was classified by six types on nasal bone CT: unilateral, bilateral, open book, impacted, greenstick, comminuted. The external deviation of nasal bone (20 degree below or up) and correlation between septal fracture and nasal bone fracture were analysed by chi-square test (p<0.05). RESULTS: The incidence of each type of nasal bone fracture is unilateral (41%), bilateral (18%), open book (8%), impacted (6%), green stick (17%), and comminuted (10%). The incidence of combined septal fracture was high in comminuted and impacted rather than in unilateral and bilateral (p<0.05). And there was no correlation between the directions of the trauma force and nasal septal deviation. CONCLUSION: The incidence of concurrent nasal septal fracture when nasal bone fracture occur is relatively high, so we must consider nasal septum more carefully on nasal trauma.
Congenital Abnormalities ; Diagnosis ; Humans ; Incidence ; Medical Records ; Nasal Bone* ; Nasal Septum ; Nose