BACKGROUND: The verbal fluency test consists of two separate tests of semantic fluency and phonemic fluency. The performance patterns of these tests differ with the type of dementia. We studied the patterns of verbal fluency between Alzheimer's disease (AD) and subcortical vascular dementia (SVaD), and assessed the clinical utility of these tests. METHODS: The 1,475 selected participants comprised 73 normal control subjects, 673 patients with amnestic mild cognitive impairment (aMCI), 535 AD patients, 42 patients with subcortical vascular mild cognitive impairment (svMCI), and 152 SVaD patients. We analyzed the z-score for the total number of animal items as a semantic fluency index and the z-score of the phonemic total score as a phonemic fluency index. RESULTS: The performance of semantic fluency was lower than that of phonemic fluency in all groups. The SVaD group showed the worst scores and abnormal performances on both tests, while the AD group presented abnormal performance only for semantic fluency. Dividing the patients with dementia according to severity revealed a different pattern between AD and SVaD for the clinical dementia rating (CDR) stage of 0.5. The performance of the AD group declined gradually with CDR. However, the SVaD group performed very poorly in both tests even for very mild dementia (CDR stage of 0.5). The aMCI and svMCI groups exhibited similar performance patterns. CONCLUSIONS: The pattern of semantic and phonemic fluency was not clinically useful at the MCI stage, but it could be helpful in differentiating AD and SVaD in the early stage of dementia.
Alzheimer Disease* ; Animals ; Dementia* ; Dementia, Vascular* ; Humans ; Mild Cognitive Impairment ; Semantics ; Task Performance and Analysis*

Locally advanced non-small cell lung cancer (NSCLC) is a heterogeneous disease, and we have embarked on an era where patients will benefit from individualized therapeutic strategies based on identifiable molecular characteristics of the tumor. The landmark studies demonstrating the importance of molecular characterization of tumors for NSCLC patients, the promising molecular pathways, and the potential molecular targets/agents for treatment of this disease will be reviewed. Understanding these issues will aid in the development of rationally designed clinical trials, so as to determine best means of appropriately incorporating these molecular strategies, to the current standard of radiation and chemotherapy regimens, for the treatment of locally advanced NSCLC.
Carcinoma, Non-Small-Cell Lung ; Combined Modality Therapy ; Humans ; Precision Medicine ; Lung Neoplasms ; Receptor, Epidermal Growth Factor

OBJECTIVES: The spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits. METHODS: Diagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases. RESULTS: Our patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients. CONCLUSION: We discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.
Back Pain ; Decompression, Surgical ; Hematoma, Epidural, Spinal ; Humans ; Male ; Neurologic Manifestations ; Retrospective Studies

With rapid population aging, the socioeconomic burden caused by dementia care is snowballing. Although a few community-based studies of Alzheimer's disease (AD) have been performed in Korea, there has never been a nationwide hospital-based study thereof. We aimed to identify the demographics and clinical characteristics of mild-to-moderate AD patients from the Clinical Research Center for Dementia of Korea (CREDOS) registry. A total of 1,786 patients were consecutively included from September 2005 to June 2010. Each patient underwent comprehensive neurological examination, interview for caregivers, laboratory investigations, neuropsychological tests, and brain MRI. The mean age was 74.0 yr and the female percentage 67.0%. The mean period of education was 7.1 yr and the frequency of early-onset AD (< 65 yr old) was 18.8%. Among the vascular risk factors, hypertension (48.9%) and diabetes mellitus (22.3%) were the most frequent. The mean score of the Korean version of Mini-Mental State Examination (K-MMSE) was 19.2 and the mean sum of box scores of Clinical Dementia Rating (CDR-SB) 5.1. Based on the well-structured, nationwide, and hospital-based registry, this study provides the unique clinical characteristics of AD and emphasizes the importance of vascular factors in AD in Korea.
Aged ; Aged, 80 and over ; Alzheimer Disease/complications/*diagnosis ; Brain/radionuclide imaging ; Caregivers ; Dementia/diagnosis ; Demography ; Diabetes Mellitus, Type 2/etiology ; Female ; Hospitals ; Humans ; Hypertension/etiology ; Interviews as Topic ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Questionnaires ; *Registries ; Republic of Korea ; Risk Factors

The present study was conducted to examine the morphology and antigenicity of Photobacterium damselae subsp. piscicida by culturing the bacterium in vivo in the peritoneal cavity of sea bass (Dicentrarchus labrax) within dialysis bags with either a low molecular weight (LMW) cut-off of 25 kDa or a high molecular weight (HMW) cut-off of 300 kDa. Differences were observed in the growth rate between the bacteria cultured in vivo or in vitro. Bacteria cultured in vivo were smaller and produced a capsular layer, which was more prominent in bacteria cultured in the HMW bag. Antigenicity was examined by Western blot analysis using sera from sea bass injected with live Ph. d. subsp. piscicida. The sera recognised bands at 45 and 20 kDa in bacteria cultured in vivo in the LMW bag. Bacteria cultured in vivo in the HMW bag did not express the 45 kDa band when whole cell extracts were examined, although the antigen was present in their extracellular products. In addition, these bacteria had a band at 18 kDa rather than 20 kDa. Differences in glycoprotein were also evident between bacteria cultured in vitro and in vivo. Bacteria cultured in vitro in LMW and HMW bags displayed a single 26 kDa band. Bacteria cultured in the LMW bag in vivo displayed bands at 26 and 27 kDa, while bacteria cultured in vivo in the HMW bag possessed only the 27 kDa band. These bands may represent sialic acid. The significance of the changes observed in the bacterium's structure and antigenicity when cultured in vivo is discussed.
Animals ; Antigenic Variation/*genetics ; Antigens, Bacterial/genetics/*immunology ; Bass/*immunology/microbiology ; Blotting, Western ; Carbohydrates/analysis ; Electrophoresis, Polyacrylamide Gel ; Membranes, Artificial ; Microscopy, Electron, Transmission ; N-Acetylneuraminic Acid/genetics/*immunology ; Photobacterium/genetics/*immunology/ultrastructure

The antigenicity of Photobacterium damselae (Ph. d.)subsp. piscicida, cultured in four different growth media[tryptone soya broth (TSB), glucose-rich medium (GRM),iron-depleted TSB (TSB+IR-), and iron-depleted GRM(GRM+IR-)] was compared by enzyme-linked immuno-sorbent assay (ELISA) and Western blot analysis usingsera obtained from sea bass (Dicentrarchus labrax) raisedagainst live or heat-killed Ph. d. subsp. piscicida. Theantigenic expression of Ph. d. subsp. piscicida was found todiffer depending on the culture medium used. A significantlyhigher antibody response was obtained with iron-depletedbacteria by ELISA compared with non-iron depletedbacteria obtained from the sera of sea bass raised againstlive Ph. d. subsp. piscicida. The sera from sea bass raisedagainst live bacteria showed a band at 22kDa in bacteriacultured in TSB+IR- or GRM+IR- when bacteria thathad been freshly isolated from fish were used for thescreening, while bands at 24 and 47kDa were observedwith bacteria cultured in TSB or GRM. When bacteriawere passaged several times on tryptic soya agar prior toculturing in the four different media, only bands at 24 and47kDa were recognized, regardless of the medium used toculture the bacteria. It would appear that the molecularweight of Ph. d. subsp. piscicida antigens change in thepresence of iron restriction, and sera from sea bassinfected with live bacteria are able to detect epitopes onthe antigens after this shift in molecular weight.
Animals ; Antibodies, Bacterial/blood ; Antigens, Bacterial/immunology/*metabolism ; Bass/blood/*immunology ; Blotting, Western/veterinary ; Cell Count/methods ; Culture Media ; Enzyme-Linked Immunosorbent Assay/veterinary ; Fish Diseases/immunology/*microbiology ; Molecular Weight ; Pasteurella Infections/immunology/microbiology/*veterinary ; Photobacterium/*immunology

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.
Axis, Cervical Vertebra ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dipyridamole ; Echocardiography* ; Heart Ventricles ; Humans* ; Male ; Myocardial Infarction ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Cesarean hysterectomy is associated with high risks of severe blood loss, postoperative complication, and maternal morbidity. This study was undertaken to identify the risk factors of cesarean hysterectomy and to reduce the postoperative complications and maternal morbidity. There were 6,362 deliveries between January 1992 and December 1996 at department of obstetrics and gynecology, Inchon Christian Hospital. 1'he results of this study were as follows, 15 cases of cesarean hysterectomy were performed during this period. Cesarean hysterectomy was performed in 10 cases (0.32 %) among 3178 cesarean deliveries and in 5 cases (0.16 %) among 3184 vaginal deliveries. The incidence of cesarean hysterectomy was 0.24 % (15/6,362). The age of patients ranged from 24 to 38 years old. The maternal mortality and morbidity were 0 % (0/15) and 86.7% (13/15), respectively. Indications for cesarean hysterectomy were uterine atony (53.3 %), uterine myoma with pregnancy (20.0 %), placenta accreta and/or increta(20.0 %), and placenta previa (6.7 %) in orders. The associated risk factors of cesarean hysterectomy were prior cesarean delivery (46.7 %) and placenta previa (6.7 %). The postoperative complications were anemia (60.0%), febrile morbidity (13.3 %), paralytic ileus (6.7 %), and wound disruption (6.7 %). We concluded that risk factors of cesarean hysterectomy were cesarean delivery, prior cesarean delivery, uterine myoma with pregnancy, placenta accreta and/or increta, and placenta previa and that sufficient fresh blood and careful prenatal care were needed in risk group of postpartum bleeding.
Adult ; Anemia ; Gynecology ; Hemorrhage ; Humans ; Hysterectomy* ; Incheon ; Incidence ; Intestinal Pseudo-Obstruction ; Leiomyoma ; Maternal Mortality ; Obstetrics ; Placenta Accreta ; Placenta Previa ; Postoperative Complications ; Postoperative Hemorrhage ; Postpartum Period ; Pregnancy ; Prenatal Care ; Risk Factors ; Uterine Inertia ; Wounds and Injuries

Growth Patterns of cranium measured directly as head circumference have been well documented. With the recent progress in CT, it is easy to measure the size and cross sectional area of the structure. The author chose themidvnetricular level of brain CT scan and measured the product of maximum anteroposterior and lateral dimension and cross sectional area. The age of infants ans children was 0 to 2 years old. The author obtained the following results through statistical analysis; 1. The maximum anteroposterior dimension and the cross sectional area were obtained through the computerized program of CT scanner. Using these measurements, monthly growth curve was obtained and which shows accelarated growth in the initial 12 months especially during the first four months, and followd by reduced rate of growth in the next 12 months. 2. Comparing the size of the calvarium between sexed,females' were somewhat larger than males', but there was no statistical significance. 3. Comparing the crosssectional area with the head circumference, high correlation was seen(correlation coefficient=0.96). Similarelationship was also seen between the product of cranial linear dimensions and the head circumference(correlationcoefficient=0.93). Also statistically significant relationship was noted between the cross sectional area and theproduct of the cranial linear dimensions(correlation coefficient=0.97). 4. Using the cross sectional area and theproduct of cranial linear dimenstions, monthly average value and the 95% significant range were obtained which canbe used as indices for the growth and development of cranium. Of these, the product of cranial linear dimensionscan eadily be measured by brain CT images, which may be useful on practical basis.
Brain ; Child ; Growth and Development ; Head ; Humans ; Infant ; Skull ; Tomography, X-Ray Computed

Currently transcatheter arterial embolization(TAE) is widely used in Korea as a palliative treatment inpatients with inoperable heptocellular carcinoma. Embolization of cystic artery is frequently unavoidable in TAE but the effect on gallbladder, its significance and sonographic findings have not yet been fully as certained. We analyzed 29 cases of gallbladder in post TAE state by means of sonographic evaluation. The results were as follows. 1. Initial change was observed on the 1st day of TAE. 2. Maximum enlargement of the gallbladder occurred within 3 days. 3. Relief of pain was mostly noted in one week. 4. Ultrasonographic findings are: a) Enlargement ofthe gallbladder: 27 cases b) Sonolucent layer within the wall: 5 cases c) Thickening of the wall: 27 cases d)Sludge formation: 6 cases e) Pericholecystic anechoic area: 3 cases 5. No surgical intervention was necessary for complication of gallbladder, if ever: some medical treatment was sufficient. 6. Non-visualization of gallbladder was experienced, possibly due to atrophic changes. 7. Even in the case of cystic artery salvation, mild gallbladder changes were still observed. 8. No significant difference as sonographic findings was descernable inuse of various embolic materials
Arteries ; Gallbladder* ; Humans ; Inpatients ; Korea ; Palliative Care ; Ultrasonography