Usefulness of Verbal Fluency Performance as Follow-up Screening Tool in Patients With Mild to Moderate Alzheimer's Disease

BACKGROUND: Impaired verbal fluency in Alzheimer's disease (AD) has been well documented. Furthermore, crosssectional studies suggest that semantic fluency is disproportionately impaired relative to phonemic fluency in AD. The aim of this study was to determine the ability of fluency measures as follow-up screening tool for mild to moderate AD. METHODS: Participants were recruited from AD patients in mild to moderate stages. We annually evaluated semantic (animal, supermarket) and phonemic (giyeok, siot, ieung) fluency and tested other extensive neuropsychological measures for two years. RESULTS: A total of 33 AD patients were included at baseline and 1-year follow-up, who were aged 70.18+/-5.97 years at baseline. Eleven patients completed a 2-year follow-up. Phonemic fluency total score was not significantly changed during the study period. However, semantic fluency total score tended to decline annually, and significantly declined at 2-year follow-up compared to baseline. In addition, difference score (semantic fluency minus phonemic fluency) was significantly decreased at every follow-up compared to previous year. In Pearson correlation analyses between changes of verbal fluency and other neuropsychological measures, changes of semantic fluency appeared to be significantly correlated with neuropsychological measures much more than changes of phonemic fluency. CONCLUSIONS: Significant longitudinal declines in semantic fluency compared to phonemic fluency seem to be consistent with previous cross-sectional studies. These patterns of changes in verbal fluency were observed even at an interval of one year follow-up in our study. The verbal fluency might be useful follow-up screening test for mild to moderate AD in the memory clinic setting.

Cognitive Profiles of Lamotrigine in Epilepsy Patients : A Comparative Study with Valproate / 대한간질학회지

PURPOSE: To identify cognitive effects of lamotrigine (LTG) compared with valproate (VPA) in epilepsy patients after 1 year of treatment. METHODS: Cognitive tests and subjective complaints of 22 patients with LTG monotherapy (50-200 mg/day) were retrospectively compared with those of 22 patients with VPA monotherapy (500-1300 mg/day) at 1 year of medication. RESULTS: LTG group did not show any significant difference in the performance of cognitive tests compared with VPA group. The incidence of cognitive complaints between two drugs were also not different. Both groups showed a better performance of list learning and Trail Making Test type A after antiepileptic drug medication. CONCLUSION: The impact of LTG and VPA monotherapy on cognitive functioning is similar. Both drugs may not be harmful or rather slightly beneficial for cognitive functions.

A Case of Recurrent Hypersomnia

Recurrent hypersomnia is a disorder characterized by recurrent episodes of hypersomnia that typically occur weeks or months apart. We describe a 60-year-old woman with a four-year history of recurrent hypersomnia. Physical examinations, laboratory tests, and brain MRI showed no significant abnormality in the patient. Nocturnal polysomnographic study showed high sleep efficiency, absent sleep stage 3 and 4, and reduced sleep latency. The multiple sleep latency tests showed short sleep latency and five episodes of sleep-onset REM periods. This is the oldest known case of recurrent hypersomnia.

Three cases of pancreas allograft dysfunction

We present dincopathologic features of three cases of biopsy-proven pancreas allograft dysfunction in Korea. All patients had advanced insulin-dependent diabetes mellitus (IDDM). Case 1 was a 30-year-old woman who underwent a simultaneous pancreas-kidney transplantation. Urinary infection developed 6 days after the operation, which remitted and reappeared, when urine amylase level was normal. Since the 55th day after the operation, intermittent hematuria has persisted. Cytomegalovirus inclusions were detected on the urinary bladder and grafted duodenal mucosa. The graft was removed due to perforation of the grafted duodenum and panperitonitis. Case 2 was a 27-year-old man undergoing pancreas transplantation alone (PTA). Ten days after the transplatation, the level of 24 urine amylase decreased and the graft was not delineated by 99mTc DTPA scintigraphy. Allograft needle biopsy revealed multiple acinar cell necrosis and mild lymphocytic infiltration which were compatible with mild acute rejection. Case 3 was a 25-year-old man undergoing cadevaric PTA. Three months after the transplantation, graft was removed due to gastric perforation associated with cytomegalovirus and angiodestructive fungal infection. Various causes of pancreas allograft dysfunction can be diagnosed by needle biopsy, thus appropriate biopsy specimen should be taken using improved biopsy technique.

Operative Treatment of Tibial Bicondylar Fracture / 대한정형외과학회잡지

Fractures involving both tibial plataeus result form high energy trauma such as a traffic accidents or falls, and it is frequently accompanied by soft tissue injuries. Thus it is very difficult to treat these fractures satisfactorily and severe complications can be caused. The purpose of study is to analyze the clinical results, complication and factors influencing the results after open reduction and internal fixation of tibial bicondylar fractures. Twenty cases(19 patients) of tibial bicondylar fractures which had been treated by open reduction and internal fixation from January 1989 to December 1994 were analyzed after 1 to 5 years follow-up. The results were as follows. 1. By AO classification, the most common type was C3(13 cases). 2. According to Blokker's criteria, 5 cases was unsatisfactory and all of these cases were C3. 3. Unsatisfactory results were 3 cases of reduction loss(angular deformity), one case of deep infection and one case of unresolved peroneal nerve palsy. 4. Tibial tubercle osteotomy, bone graft and medial buttress plate were important for anatomical reduction and maintenance.

The Unstable Intertrochanteric Fractures of Femur Treated with Sliding Compression Hip Screw: The Comparison between Anatomical Reduction and Non-Anatomical Reduction Groups / 대한정형외과학회잡지

Due to the instability of intertrochanteric fractures in elderly patients, various methods of reduction and fixation were introduced to obtain stable reduction and solid union, But there have been many controversies regarding advantages between anatomical reduction group and non-anatomical reduction group. The authors analyzed the 68 unstable intertrochanteric fractures out of total 94 cases of intertrochanteric fractures treated from Jan. 1988 to Jan. 1994 with mean follow-up 17 months and evaluated the radiologic and clinical results between those two groups. The results were obtained as follows: 1. The most common cause was low energy injury and according to the Tronzo classification, the type III was most common in 54 cases (79.4%). 2. The average union time was 14.0wks (84%), the union rate was low in the medialized reduction group(A-P) and anterior displaced reduction group(A-P), anterior displaced and anatomical reduction groups(Lateral). 3. The compression length more than 10mm of lag screw was deep in medialized reduction group(A-P), another displaced and anatomical reduction groups(Lateral). 4. The average length of lag screw sliding was 9.2mm and depth sliding of 6.8mm (74%) was occurred within immediate postoperative 1 month.