Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. As there is limited information on long-term outcome of subclinical varicoceles due to challenges in diagnosis and management, we performed a single-institution, retrospective review of patients from October 1999 to October 2014 with subclinical varicocele and with available US studies reviewed by a single radiologist. Subclinical varicocele was defined as dilation of the pampiniform venous plexus on US involving ≥2 vessels with diameter >2.5 mm, without clinical varicocele on physical examination or prior inguinal surgery. Thirty-six of 98 patients identified were confirmed as having a subclinical varicocele and analyzed. The mean age at initial visit was 15.5 years, with a mean follow-up of 26.5 months. The majority were right-sided (69.4%, n = 25), usually with a contralateral clinical varicocele. Testicular asymmetry (>20% volume difference of the affected side by testicular atrophy index formula) was assessed in 9 patients with unilateral subclinical varicocele without contralateral clinical or subclinical varicocele and observed in 1 patient. Of 17 patients with follow-up, 3 (17.6%) progressed to clinical varicocele without asymmetric testicular volume, as most remained subclinical or resolved without surgery. In our experience, subclinical varicoceles appeared unlikely to progress to clinical varicoceles, to affect testicular volume, or to lead to surgery. Although our study is limited in numbers and follow-up, this information may aid clinical management strategies and guide future prospective studies.
Adolescent ; Boston ; Child ; Humans ; Male ; Physical Examination/methods* ; Prospective Studies ; Retrospective Studies ; Treatment Outcome ; Varicocele/therapy* ; Young Adult

BACKGROUND: To elucidate the earliest changes of language function in patients with dementia of Alzheimer's type (DAT), performance on the various semantic language tasks were compared between patients with amnestic mild cognitive impairment (aMCI) (n=20), mild DAT (n=20) and normal cognition elderly individuals (NC, n=20). METHODS: Language tasks included levels of word, sentence and discourse. In the word level, confrontation naming test (Korean version-Boston Naming Test, K-BNT) and the verbal fluency (semantic and phonemic fluency) tasks were used. In the sentence level, the verbal definition tasks including 24 nouns four categories were used. In the discourse level, the Boston Cookie-Theft picture description task was used. The picture description task was analyzed for both productive aspect (total number of sentences, total number of phrases and phrases per sentence) and semantic aspect (ratio of CIU: Correct Information Unit). RESULTS: The results from this study are as follow: 1) In the confrontation naming test, mild DAT group showing worse performances than the NC and aMCI group. However, no differences were observed between the NC and aMCI group. 2) The performances of verbal fluency task showed significantly differences between the all groups. 3) In the verbal definition task, performances of NC group showing better performances than aMCI and mild DAT group. However, no differences were observed between the aMCI and mild DAT group. 4) In the picture description task, performances of the aMCI and mild DAT group were non-informative and inefficient in semantic aspect compared to the NC group. However, no differences were observed between the three groups on productive aspect. CONCLUSIONS: These results demonstrated that the deficit of semantic language is readily identified in the aMCI stage, and it can be revealed by tasks of sentence and discourse level.
Aged ; Boston ; Cognition ; Dementia ; Humans ; Mild Cognitive Impairment ; Semantics

BACKGROUND: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period. METHODS: Twenty-one patients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment. RESULTS: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months. CONCLUSIONS: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.
Boston ; Carpal Tunnel Syndrome ; Electrophysiology ; Hand ; Humans ; Paresthesia ; Triamcinolone

PURPOSE: The importance of occlusal contacts of the natural dentition for durability of teeth, mandibular stabilization, and restorative dentistry is well known. The purpose of this study is to analyze the occlusal contact and guidance pattern of Koreans by evaluating the static occlusion on maximal intercuspal position and measuring dynamic occlusion during straight protrusion. MATERIALS AND METHODS: The occlusal contacts at maximal interincisal position and the occlusal guidance pattern during straight protrusion of 29 subjects were recorded with shimstock foil (Whaledent, Langenau, Germany), T-Scan III (Tekscan Inc., Boston, MA, USA), polyvinylsiloxane registration material (Genie Bite, Sultan Healthcare, Hackensack, NJ, USA) and compared. Occlusal registration procedures were repeated 3 times. The position was fixed to an upright position and the head position was fixed with the Frankfurt horizontal plane paralleling the horizontal plane. Fisher's Exact Test (R-General Public License, ver. 2.14.1) and Pearson's Test were used to assess the significance level of the differences between the experimental groups (alpha=.05). RESULTS: When using shimstock foil, T-Scan III system, and polyvinylsiloxane registration material, most of the patients showed contact on anterior, premolar, and molar teeth during maximal intercuspal position. Approximately 51% of maximal intercuspal position showed anterior contact using shimstock foil. When examining the protrusive movement using shimstock foil and T-Scan III system, guidance pattern with the central incisor was the most common. CONCLUSION: During maximal intercuspal position, there were cases in which not all of the teeth showed occlusal contact. During mandibular protrusive movements, one or more maxillary central incisors frequently joined in straight protrusion and the posterior teeth were disoccluded. Therefore, the anterior teeth protect the posterior teeth, and vice versa. Thus, mutually protected occlusion should be applied when reconstructing occlusion.
Bicuspid ; Bites and Stings ; Boston ; Delivery of Health Care ; Dental Occlusion ; Dentistry ; Dentition ; Eugenol ; Head ; Humans ; Incisor ; Licensure ; Molar ; Tooth ; Zinc Oxide

BACKGROUND AND PURPOSE: The aims of this study were to elucidate the cognitive functions of narcoleptics and determine whether intelligence protects against cognitive dysfunction and depressive mood in these patients. METHODS: Sixty-six subjects (33 narcoleptics, 33 controls) were administered a battery of neuropsychological tests and an individual standardized intelligence test. The cognitive functions of the narcoleptic patients and the healthy controls were compared, as were those of high-IQ and mid-to-low-IQ narcoleptic patients. RESULTS: Narcoleptics exhibited significantly lower scores in the Corsi Block-Tapping Test forward and backward, and the digit symbol tests, and significantly higher Beck Depression Inventory scores than the controls. However, verbal attention, verbal-visual long-term memory, and executive function task scores did not differ significantly between patients and controls. The mid-to-low-IQ patient group had lower mean digit span backward test, phonemic and semantic fluency Controlled Oral Word Association Test and Korean version of the Boston Naming Test scores, and a higher total score and general depressive symptoms subscales Beck Depression Inventory score than the high-IQ patient group. However, controls exhibited no IQ-related differences in cognitive performance or depressive mood. Patients in the high-IQ group exhibited impaired visual attention and working memory as compared with controls. CONCLUSIONS: The findings of the present study show that narcolepsy patients have deficits in visual attention and visual working memory, and tend to feel more general depressive symptoms but not somatic symptoms than their control, nonnarcoleptic counterparts. In addition, it appears that higher intelligence protects against cognitive dysfunction and depressive mood.
Boston ; Depression ; Executive Function ; Humans ; Intelligence ; Intelligence Tests ; Memory ; Memory, Long-Term ; Memory, Short-Term ; Narcolepsy ; Neuropsychological Tests ; Semantics ; Word Association Tests

PURPOSE: The purpose of this study was to evaluate cross-sectional area of the median nerve using ultrasound in patients with carpal tunnel syndrome before and after endoscopic intervention, and to verify the level at which it can be used in prediction of outcome. MATERIALS AND METHODS: A prospective study was conducted in 21 patients who underwent endoscopic carpal tunnel release from March 2011 to March 2012. Median nerve cross-sectional area was measured before the operation and three months after the operation at the level of lunate, pisiform and hamate. The Boston questionnaire was evaluated before the operation and three months after the operation, and then allocated as two groups (group I: symptom improvement of more than 25%, group II: symptom improvement less than 25%). Then, differences of cross-sectional area between preoperative measurement and postoperative measurement on three levels were compared between the two groups. RESULTS: Nineteen patients were females and two were males ranging in age between 35-79 years (mean, 55.4 years). Significant differences were observed between the two groups at the lunate level. However, at the level of pisiform and hamate, no differences were observed between the two groups. CONCLUSION: Measurement of median nerve cross-sectional area at the lunate level showed significant correlation with outcome of carpal tunnel release.
Boston ; Carpal Tunnel Syndrome ; Female ; Humans ; Male ; Median Nerve ; Prognosis ; Prospective Studies ; Surveys and Questionnaires

PURPOSE: The aims of this study were to introduce a new method of percutaneous carpal tunnel release and report its results. MATERIALS AND METHODS: After preoperative ultrasonographic mapping, a percutaneous carpal tunnel release was performed using the wire rope through two skin needle punctures. Forty wrists of 30 patients were evaluated restrospectively in terms of the symptomatic resolution and complications. The mean age of patients was 53.7 years ranging from 44 to 79 years. The mean follow-up period was 12.8 months ranging from 6 to 18 months. RESULTS: All cases showed complete relief or marked improvement of symptoms postoperatively. There was no neurovascular injury or other major complication. At postoperative 6 months follow-up, according to the Boston questionnaire, symptom severity score improved from 3.67+/-0.25 preoperatively to 1.55+/-0.33 postoperatively, and functional status score improved from 3.52+/-0.38 preoperatively to 2.09+/-0.42 postoperatively. All patients regained grip strength and pinch strength after surgery. CONCLUSION: The percutaneous carpal tunnel release using the preoperative ultrasonograhic mapping and the wire rope is an effective, reliable and safe method with the benefits of less postoperative pain and early recovery.
Boston ; Carpal Tunnel Syndrome ; Follow-Up Studies ; Hand Strength ; Humans ; Needles ; Pain, Postoperative ; Pinch Strength ; Punctures ; Surveys and Questionnaires ; Skin ; Wrist

OBJECTIVES: This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. METHODS: A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. RESULTS: Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. CONCLUSION: Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group.
Aged ; Boston ; Brain ; Depression ; Executive Function ; Humans ; Magnetic Resonance Imaging ; Stroop Test ; Trail Making Test ; Treatment Outcome

BACKGROUND: We analyzed the performance on a naming test and the correlations between the scores on the naming test and neuropsychological test scores in patients with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). METHODS: The subjects included 69 patients with MCI and 33 patients with mild AD. We performed general cognitive functions, the Korean version of the Boston Naming Test (K-BNT), the digit span test, the Rey figure copy test (RCFT), the Seoul Verbal Learning Test (SVLT), and frontal function tests. The detailed items of the K-BNT were analyzed for the two subject groups, and the correlations between the K-BNT scores and those of the neuropsychological tests were examined. RESULTS: Significant differences were observed on the item for the number of correct answers after two syllables on the K-BNT task in patients with AD and MCI (p<0.05). A qualitative analysis of the incorrect K-BNT responses showed that both the AD and MCI groups made semantic errors more than visuoperceptual and phonemic errors. Significant correlations were found among the Mini-Mental State Examination, the Global Deterioration Scale, clinical dementia rating, digit span, SVLT delayed recall, RCFT and RCFT delayed recall, and the Stroop test color reading items (p<0.01). CONCLUSION: Our result suggests that semantic errors gradually increase with the progress of cognitive disability in the state preceding AD among patients with MCI.
Alzheimer Disease ; Boston ; Coat Protein Complex I ; Dementia ; Humans ; Mild Cognitive Impairment ; Neuropsychological Tests ; Semantics ; Stroop Test ; Verbal Learning

OBJECTIVE: To verify the feasibility of initial parameters of ultrasonography or electromyography for the prediction of effect after steroid injection therapy in a carpal tunnel syndrome (CTS) patient. METHOD: We recruited individuals with clinical and electrodiagnostic evidence of CTS. Results from the Boston self-assessment questionnaire, median motor and sensory nerve conduction studies, and median nerve ultrasonography were evaluated at baseline, 1 month, and 6 months after injection. Evaluation of median nerve ultrasonography parameters included measurements taken at the maximal swelling point (MS), 2 cm proximal from MS (2MS), and 12 cm proximal from MS (12MS), and its ratio (MS/12MS, 2MS/12MS) was calculated. The correlation between improvement of the symptom score after treatment and baseline parameters was estimated. RESULTS: Fourteen individuals (14 women, mean age 53.8 years) with 22 affected wrists were enrolled. After steroid injection therapy, clinical and electromyographic parameters showed significant improvements at 1 month or 6 months after injection, and ultrasonographic parameters showed significant changes in maximal area and area ratio (MS/12MS) of the median nerve. Symptom score improvement showed a positive correlation in the initial 2MS and ratio of 2MS/12MS after 6 months (p<0.05). CONCLUSION: Most of the improvements occurred during the first month after injection and lasted up to 6 months. The initial median nerve swelling and its ratio may be a useful predictor of response after steroid injection.
Boston ; Carpal Tunnel Syndrome ; Electromyography ; Female ; Humans ; Median Nerve ; Neural Conduction ; Self-Assessment ; Wrist ; Surveys and Questionnaires