The central type of Tapia’s syndrome is an extremely rare presentation, characterized by unilateral paralysis of the vagal and hypoglossal nerves, contralateral hemiparesis, or hemihypesthesia. This report describes a case of a middle-aged patient who developed central Tapia’s syndrome due to a right vertebral artery dissecting aneurysm (VADA). The patient complained about swallowing difficulty and odynophagia. Right vocal cord paralysis, mild tongue deviation to the right side, left hypesthesia, and decreased temperature sensation with left hemiparesis were observed in neurologic exams. A right VADA and compression of the medulla oblongata due to the VADA were diagnosed on magnetic resonance imaging. Endovascular flow diversion of the right VADA was performed. After 1 year, all neurological symptoms and vocal cord paralysis were nearly resolved, but left hypesthesia remained with decreased nociception. We present and discuss how a VADA caused those symptoms and propose endovascular flow diversion as a treatment option.

The central type of Tapia’s syndrome is an extremely rare presentation, characterized by unilateral paralysis of the vagal and hypoglossal nerves, contralateral hemiparesis, or hemihypesthesia. This report describes a case of a middle-aged patient who developed central Tapia’s syndrome due to a right vertebral artery dissecting aneurysm (VADA). The patient complained about swallowing difficulty and odynophagia. Right vocal cord paralysis, mild tongue deviation to the right side, left hypesthesia, and decreased temperature sensation with left hemiparesis were observed in neurologic exams. A right VADA and compression of the medulla oblongata due to the VADA were diagnosed on magnetic resonance imaging. Endovascular flow diversion of the right VADA was performed. After 1 year, all neurological symptoms and vocal cord paralysis were nearly resolved, but left hypesthesia remained with decreased nociception. We present and discuss how a VADA caused those symptoms and propose endovascular flow diversion as a treatment option.

Objective: Microsurgical treatment could be a good alternative for the treatment of recurrent cerebral aneurysm after coil embolization. The purpose of this study was to present our experience of microsurgical treatment for recurrent cerebral aneurysm previously treated using coil embolization. Methods: From June 2012 to May 2019, 34 patients consecutively received microsurgical treatment for a recurrent cerebral aneurysm previously treated using coil embolization after it ruptured. Results: Of the 34 patients with aneurysm, 33 had the aneurysm located in the anterior circulation. The most common location was the anterior communicating artery (13 cases). Immediate radiologic outcome at coil embolization was completed (n=6), residual neck (n=26), and residual sac (n=2). The reason for microsurgical treatment included rebleeding (n=12), persistent residual sac (n=1), and recurrence on follow-up study (n=21). Rebleeding occurred within 10 days after coil embolization in 10 cases, and the other 2 were due to regrowth. In the 20 recurred and saccular aneurysms, coil compaction was present in 11 aneurysms and regrowth in 9 aneurysms. Simple neck clipping (n=29) and clipping with coil mass extraction (n=3) was possible in the saccular aneurysms. The blood blister like aneurysm (n=2) were treated using bypass and endovascular internal carotid artery trapping. In the follow-up study group after microsurgical treatment there were no severe complications due to the treatment. Age, cause of retreatment, and modified Rankin Scale before microsurgery were associated with good outcome (p<0.001). Conclusions Microsurgical treatment may be a viable and effective option for treating recurrent aneurysms previously treated by endovascular techniques.

PURPOSE: The purposes of this study were to investigate the distribution of the visceral fat area (VFA) and general obesity and to compare visceral and general obesity as predictors of surgical outcomes of a colorectal cancer resection. METHODS: The prospectively collected data of 102 patients with preoperatively-diagnosed sigmoid colon or rectal cancer who had undergone a curative resection at Pusan National University Yangsan Hospital between April 2011 and September 2012 were reviewed retrospectively. Men with a VFA of >130 cm2 and women with a VFA of >90 cm2 were classified as obese (VFA-O, n = 22), and the remaining patients were classified as nonobese (VFA-NO, n = 80). RESULTS: No differences in morbidity, mortality, postoperative bowel recovery, and readmission rate after surgery were observed between the 2 groups. However, a significantly higher number of harvested lymph nodes was observed in the VFA-NO group compared with the VFA-O group (19.0 +/- 1.0 vs. 13.5 +/- 1.2, respectively, P = 0.001). CONCLUSION: Visceral obesity has no influence on intraoperative difficulties, postoperative complications, and postoperative recovery in patients with sigmoid colon or rectal cancer.
Busan ; Colon, Sigmoid ; Colorectal Neoplasms* ; Female ; Gyeongsangnam-do ; Humans ; Intra-Abdominal Fat* ; Lymph Nodes ; Male ; Mortality ; Obesity ; Obesity, Abdominal ; Postoperative Complications ; Prospective Studies ; Rectal Neoplasms ; Retrospective Studies

BACKGROUND: The 30 mg pioglitazone tablet was recently introduced in Korea; no study has yet compared its glucose-lowering or weight gain effects to the 15 mg tablet in Korean patients with type 2 diabetes mellitus (T2DM). METHODS: The electronic medical records of 45 patients with T2DM with glycated hemoglobin (HbA1c) levels > 7.0%, despite taking 15 mg/day pioglitazone and a stable dose of other diabetes drugs for 3 months, were retrospectively reviewed. RESULTS: After dose up-titration, HbA1c levels decreased at 3- and 6-month follow-ups compared with baseline (8.5% at baseline vs. 8.2% at 3 months vs. 7.9% at 6 months; baseline vs. 3 months, P = 0.106; baseline vs. 6 months, P = 0.005; 3 months vs. 6 months, P = 0.096). In the subgroup analysis of 36 patients taking pioglitazone, sulfonylurea, and metformin, HbA1c levels also decreased at 3- and 6-month follow-ups compared with baseline (8.5 % vs. 8.2 % vs. 7.9%; baseline vs. 3 months, P = 0.289; baseline vs. 6 months, P = 0.014; 3 months vs. 6 months, P = 0.232). There was no significant body weight change (70.8 kg vs. 70.7 kg vs. 71.0 kg). CONCLUSION: Up-titrating from 15 mg to 30 mg of pioglitazone in patients with inadequate glycemic control (HbA1c > 9%) who were also taking sulfonylurea and metformin showed additive glucose-lowering effects without significant weight gain in Korean patients with T2DM.
Body Weight ; Body Weight Changes ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Electronic Health Records ; Follow-Up Studies ; Hemoglobin A, Glycosylated ; Humans ; Korea ; Metformin ; Retrospective Studies* ; Thiazolidinediones ; Weight Gain

As the official organization of psychiatrists in South Korea since 1945, the Korean Neuropsychiatric Association (KNPA) has played important contribution in academic and mental health development. It is time to plan long-term policy for future strategy. Thus, the authors tried to perform brainstorming in members of a special task force team and survey for internal specialists in the KNPA and external professionals. Based on the above major issues and results of the survey, the authors suggest the overall direction of the long and mid-term policy for KNPA.
Advisory Committees ; Health Policy ; Korea ; Mental Health ; Psychiatry ; Specialization

The Korean Neuropsychiatric Association (KNPA) should protect members' rights, and also plan long-term policy for public activity in a society. In these efforts, creation of mission, vision, and core values is of utmost importance. Second, effective communication among members is important for sharing and discussing the mission, vision, and core values of the KNPA. Third, public relations play a key role in advertising the policy and providing information. Based on the above major issues and results of representatives questionnaire, the authors suggest that careful planning of long-term policy and roles of the KNPA is needed.
Growth and Development* ; Health Policy ; Human Rights ; Humans ; Mental Health ; Missions and Missionaries ; Public Relations ; Surveys and Questionnaires

Futurology is an interdisciplinary field, studying yesterday's and today's changes, and aggregating and analyzing both lay and professional strategies and opinions with respect to tomorrow. Therefore, the purpose of this article is to provide the future direction and strategy for the advancement of Korean psychiatry based on the author's subjective opinion as well as the objective consideration of future changes in the environmental factors affecting psychiatry. First, we attempted to analyze the pros and cons of our status, according to the SWOT analysis. There are several positive factors in the outer environment, such as the increase of personal income, healthy aging people, interest in mental health, and development of a national mental health plan. Meanwhile, the negative factors affecting our future originated from the excessive control by national health insurance as well as our short capacity for social or general mental health needs. Second, we estimated the needs from future changes that might affect modern psychiatry. The future changes force us to prepare ourselves to be more competent in fulfillment of customer oriented positive mental health needs. Further, greater competency is needed in application of neurobehavioral knowledge to the clinical field. In addition, development of dedicated leadership and partnership for accomplishment of social and community based projects is also needed. In conclusion, the Korean Neuropsychiatric Association, for organizational integration of the profession, must develop a strategic plan for achievement of the ideal goal. In the first step, from 2014 to 2019, we need to develop the vision, mission, strategy and framework of our organization. And, the mission should be carried out by several task forces. Consecutively, achievements of the task force should be applied to the organizational performance. In the second step, from 2020 to 2029, full time employment of a psychiatrist for the function of executive secretary should be established. In the third step, from 2029, we need to formally participate in the national project and community program by establishment of a full time organization for the major strategic area. The suggestions could be realized by the communication and commitment of the psychiatric organization.
Advisory Committees ; Aging ; Employment ; Forecasting ; Humans ; Leadership ; Mental Health ; Missions and Missionaries ; National Health Programs ; Psychiatry

This survey was performed to analyze the usability of the third edition of the Korean breast cancer clinical practice guidelines (KBCCPG) in clinical practice. We made a questionnaire composed of 18 general and 82 specific questions regarding benign breast disease (B; 1 question); non-invasive disease (N; 12 questions); early-stage disease (E; 26 questions); advanced disease (A; 24 questions); and metastatic (M) breast cancer-related problems (19 questions). A total of 100 questionnaires, with a link to an online survey, were delivered via e-mail to over 700 members of the Korean Breast Cancer Society (KBCS), and associated academy members, over 20 days between 26th February and 16th May 2010. Out of 270 respondents who read the e-mail, 96 answered the questionnaire. Participants included 87 surgical oncologists, 5 radiation oncologists, 2 oncoplastic surgeons, 1 pathologist, and 1 medical oncologist. The third KBCCPG were perceived as differing from the second guidelines in terms of the level of clinical evidence required before choosing a recommendation. For the progress of the KBCCPG, the guideline committee should try to reinforce all courses of guideline development with several elements including data from clinical trials of Korean breast cancer patients, securing a multidisciplinary approach, developing consistent and reasonable processes for each step of the revision of the guidelines, induction of liberal scientific and ethical discussion about all issues with all KBCS members. The cost-effectiveness of healthcare and the logical development of the KBCCPG would also be ensured. Timely updates of the clinical guidelines for breast cancer treatment are essential to facilitate optimal decision-making in daily practice, and to ensure adequate patient feedback.
Aluminum Hydroxide ; Breast ; Breast Diseases ; Breast Neoplasms ; Carbonates ; Surveys and Questionnaires ; Delivery of Health Care ; Dietary Sucrose ; Electronic Mail ; Humans ; Korea ; Logic

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