In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.
Antibodies, Monoclonal, Humanized ; Bevacizumab ; Camptothecin ; Cetuximab ; Colorectal Neoplasms ; Cytotoxins ; Fluorouracil ; Hemorrhage ; Humans ; Life Expectancy ; Neoplasm Metastasis ; Organoplatinum Compounds ; Palliative Care ; Quality of Life ; Retrospective Studies ; Unnecessary Procedures

No abstract available.
Humans ; Hyperbilirubinemia, Hereditary* ; Siblings* ; Twins, Monozygotic*

Crossed aphasia refers to a combination of aphasia and right hemiparesis in a left handed person or left hemiparesis and aphasia in a dextral. While crossed aphasia is not infrequent at all among left-handers, it remains an extremely rare event in dextrals. Its incidence is probably about 0.4% after right hemispheric lesions and prevalence is about 1% among right-handed aphasics. The neurobiological mechanisms of this phenomenon are unknown, and the neuropsychological correlations are only incompletely understood. We report a case of crossed aphasia in a 61-year-old right-handed woman who presented with sudden, severe global aphasia and left hemiplegia without any personal or family history of left-handedness. Brain MR image clearly showed a right hemispheric infarction in the territory of the right middle cerebral artery and brain SPECT also displayed reduction of regional cerebral blood flow in the right hemisphere sparing the left hemisphere. In this patient, cerebral dominance for speechseems to lay in the right hemisphere, while dominance for limb praxis seemsto lay in the left as the patient did not develop right limb apraxia. This case provides evidence that cerebral dominance for speech and handedness in dextrals can be dissociated. It also suggests that crossed aphasia in a dextral may be severe and persisting.
Aphasia* ; Apraxias ; Brain ; Dominance, Cerebral ; Extremities ; Female ; Functional Laterality ; Hand ; Hemiplegia ; Humans ; Incidence ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Paresis ; Prevalence ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Gallium* ; Tuberculosis, Miliary*

No abstract available.
Emergencies* ; Emergency Medical Technicians* ; Humans ; Military Personnel* ; Republic of Korea*

Thunderclap headache refers to a sudden and severe headache that comes unexpectedly, reminding one of a clap of thunder. The initial description of this type of headache was in association with an unruptured intracranial aneurysm. It is known to be a presenting feature of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, cervical artery dissection, spontaneous intracranial hypotension, pituitary apoplexy, retroclival hematoma, and hypertensive reversible posterior leukoencephalopathy. A formula for diagnostic assessment of thunderclap headache, such as brain computed tomographic scan and spinal tap, should be established. We experienced a case of cerebral infarction presented with thunderclap headache, diagnosed using diffusion weighted magnetic resonance imaging. We suggest that, even when these patients have shown non-specific findings on neurological examination, brain computed tomography, and cerebrospinal fluid analysis, diffusion MRI should be considered for differential diagnosis of thunderclap headache in emergency medical services.
Arteries ; Brain ; Cerebral Infarction ; Diagnosis, Differential ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Emergency Medical Services ; Headache ; Headache Disorders, Primary ; Hematoma ; Humans ; Infarction, Middle Cerebral Artery ; Intracranial Aneurysm ; Intracranial Hypotension ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neurologic Examination ; Pituitary Apoplexy ; Spinal Puncture ; Subarachnoid Hemorrhage ; Venous Thrombosis

Mechanisms and causes of cerebral infarction, usually two mechanisms, are identified: hemodynamics and thrombotic or thromboembolic causes. Compressive causes by tumor are not reported in the main etiological classifications as Trial of Org10172 in Acute Stroke Treatment (TOAST) classification and ASCO (atherosclerosis, small vessel disease, cardiac source, and other causes). However tumors found in these locations often involve an intracranial portion of the internal carotid artery (ICA) and may compromise cerebral blood flow. Cerebral infarction related to meningioma, the common extra-axial brain tumor in adults, has been rarely reported. We experienced an extremely rare case of cerebellar infarction resulting from direct compression of the vertebral artery by cervical meningioma. To the best of our knowledge, there are no documented cases of a meningioma causing stroke by vertebral artery occlusion. We report on a case of meningioma presenting with cerebellar infarction as a result of vertebral artery compression.
Adult ; Brain Neoplasms ; Carotid Artery, Internal ; Cerebellum ; Cerebral Infarction ; Classification ; Heart Diseases ; Hemodynamics ; Humans ; Infarction* ; Meningioma* ; Stroke ; Vertebral Artery ; Vertigo

PURPOSE: To analyze the clinical and radiological results of the operative treatment in the avulsion fracture on the base of the fifth metatarsal. MATERIALS AND METHODS: We studied retrospectively, 11 patients of avulsion fracture on the base of the fifth metatarsal operated and followed over 1 year, from February 2000 to May 2002. There were eight men and three women and the average age was 39 years old. The mean follow up period was 14 months. Ten cases were slip-down and one case was fall from a height injuries. We used the modified Foot Score by Wiener for the clinical evaluation, and analyzed the time of union and state of reduction radiologically. RESULTS: In clinical results, we had ten excellent and one good cases by the modified Foot Score at last follow-up. In radiologic results, the complete bony union was achieved in all cases and the duration of the bony union was 37 days in average. CONCLUSION: We had good result for the avulsion fractures on the base of the fifth metatarsal treated by the operation. This study shows the operation was recommended for the moderate and severe displacement of the avulsion fractures on the base of the fifth metatarsal.
Adult ; Female ; Follow-Up Studies ; Foot ; Humans ; Male ; Metatarsal Bones* ; Retrospective Studies

BACKGROUND: The SF-6D, derived from the SF-36, is a preference-based instrument measuring health-related quality of life (HRQOL). Using this tool, we measured the HRQOL of persons disabled by stroke dwelling in Gyeongju city and identified factors affecting the HRQOL. METHODS: As of March 2008, 991 persons who had had a stroke and were aged 50 and over were identified on the Gyeongju city disabled registry. Interviewers specifically trained for this face-to-face survey gathered pertinent information including general and clinical characteristics from June to October 2008. In addition, the health status was measured using the Modified Rankin Scale, the Barthel ADL index, and the SF-36. The SF-6D index was derived from the SF-36. We analyzed the known-group construct validity and convergent validity. Finally, we performed multiple regression analyses to identify factors affecting the HRQOL. RESULTS: Of the 991 potential subjects, 498 persons participated in the interviews (response rate: 50.3%). The SF-6D indices for females and those aged 70 and over were lower than indices for males and those aged 60 and less. Correlation coefficients between the Modified Rankin Scale, the Barthel index, and the SF-6D index were relatively high (-0.533 and 0.555, respectively) and statistically significant (P<0.001). Multiple regression analyses showed that sex, age, smoking, alcohol use, comorbidity, the Modified Rankin Scale, and the Barthel index had an effect on the SF-6D index of persons with stroke, and the Barthel index was the most important factor. CONCLUSIONS: Our results indicate that the SF-6D can be a valid tool for evaluating health states of persons disabled by stroke, and functional limitation was the main factor affecting the HRQOL.
Activities of Daily Living ; Aged ; Comorbidity ; Disabled Persons ; Female ; Humans ; Male ; Quality of Life ; Smoke ; Smoking ; Stroke ; Value of Life ; Surveys and Questionnaires

Authors presented two cases of typical Groenblad-Strandberg's syndrome and reviewed concerning pathogenesis, histology, heredity and its related conditions. Followings are to be considered in these cases. 1. Pseudoxanthoma elasticum, generally considered; mainly appears from 25 to 50 years of life, but we met in case 2 that he was eleven years old. 2. In ocular complications Case 1 showed disciform macular degeneration of the left eye and macular hemorrhages in superficial layers of retina of the right eye. The other case was several retinal exudates of the left eye without any amcular complications. 3. Case 2 had suggestive signs of Paget's disease in radiograms of the skull and pelvic bone. Routine laboratery studies including serum calcium, phosphorus and alkaline phosphatase were normal. 4. Suspicious heroditary occurrence was noted in case 2. 5. There were no significant abnormalities in blood and cardiovascular system.
Alkaline Phosphatase ; Calcium ; Cardiovascular System ; Exudates and Transudates ; Hemorrhage ; Heredity ; Macular Degeneration ; Pelvic Bones ; Phosphorus ; Pseudoxanthoma Elasticum ; Retina ; Retinaldehyde ; Skull