ABSTRACT
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique which can change cortical excitability in targeted area by producing magnetic field pulses with an electromagnetic coil. rTMS treatment has been used to treat various neuropsychiatric disorders including depression. In this review, we evaluate the literature on rTMS for depression by assessing its efficacy on different subtypes of depression and different technical parameters. In particular, we focus on the results of randomized clinical trials and meta-analyses for depression after the US Food and Drug Administration approval in 2008, which acknowledged its efficacy and acceptability. We also review the new forms of rTMS therapy including deep TMS, theta-burst stimulation, and magnetic seizure therapy (MST) that have been under recent investigation. High frequency rTMS over left dorsolateral prefrontal cortex (DLPFC), low frequency rTMS over right DLPFC, or bilateral rTMS is shown to be effective and acceptable in treatment for patients with non-psychotic, unipolar depression either as monotherapy or adjuvant. Deep TMS, theta-burst stimulation and MST are promising new TMS techniques which warrant further research.
Subject(s)
Humans , Depression , Depressive Disorder , Magnetic Fields , Magnets , Prefrontal Cortex , Seizures , Transcranial Magnetic Stimulation , Treatment Outcome , United States Food and Drug AdministrationABSTRACT
BACKGROUND/AIMS: Loss of transforming growth factor beta1 (TGF-beta1) exhibits a similar pathology to that seen in a subset of individuals infected with Helicobacter pylori, including propagated gastric inflammation, oxidative stress, and autoimmune features. We thus hypothesized that gastric mucosal TGF-beta1 levels could be used to determine the outcome after H. pylori infection. METHODS: Northern blot for the TGF-beta1 transcript, staining of TGF-beta1 expression, luciferase reporter assay, and enzyme-linked immunosorbent assay for TGF-beta1 levels were performed at different times after H. pylori infection. RESULTS: The TGF-beta1 level was markedly lower in patients with H. pylori-induced gastritis than in patients with a similar degree of gastritis induced by nonsteroidal anti-inflammatory drugs. There was a significant negative correlation between the severity of inflammation and gastric mucosal TGF-beta1 levels. SNU-16 cells showing intact TGF-beta signaling exhibited a marked decrease in TGF-beta1 expression, whereas SNU-638 cells defective in TGF-beta signaling exhibited no such decrease after H. pylori infection. The decreased expressions of TGF-beta1 in SNU-16 cells recovered to normal after 24 hr of H. pylori infection, but lasted very spatial times, suggesting that attenuated expression of TGF-beta1 is a host defense mechanism to avoid attachment of H. pylori. CONCLUSIONS: H. pylori infection was associated with depressed gastric mucosal TGF-beta1 for up to 24 hr, but this apparent strategy for rescuing cells from H. pylori attachment exacerbated the gastric inflammation.
Subject(s)
Humans , Blotting, Northern , Enzyme-Linked Immunosorbent Assay , Gastritis , Helicobacter pylori , Inflammation , Luciferases , Oxidative Stress , Transforming Growth Factor beta , Transforming Growth Factor beta1 , UlcerABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation.
Subject(s)
Child , Humans , Young Adult , Anti-Bacterial Agents , Diagnosis , Hospitalization , Mycoplasma pneumoniae , Mycoplasma , Pneumonia , Pneumonia, MycoplasmaABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation.
Subject(s)
Child , Humans , Young Adult , Anti-Bacterial Agents , Diagnosis , Hospitalization , Mycoplasma pneumoniae , Mycoplasma , Pneumonia , Pneumonia, MycoplasmaABSTRACT
BACKGROUND: Malignancies are a common and important causes of exudative pleural effusions. Several tumor markers have been studied because the pleural fluid cytology and pleural biopsy specimens do not provide a diagnosis in a high percentage of malignant effusions. In an attempt to overcome this limitation, procalcitonin and C-reactive protein (CRP) in pleural effusions and serum, which are known to be inflammation markers, were measured to determine if they can differentiate an exudate from trasndate as well as the diverse causes of exudative pleural effusion. METHODS: 178 consecutive patients with pleural effusion (malignant 57, tuberculous 51, parapneumonic 31, empyema 5, miscellaneous benign 7, transudative 27)were studied prospectively. The standard parameters of pleural effusion and measured serum and pleural procalcitonin were examined using in immunoluminometric assay. The level of CRP in serum and pleural fluid was determined by turbidimetric immunoassay. RESULTS: The pleural procalcitonin levels in the exudate were significantly higher than those in the transudate, 0.81+/-3.09 ng/mL and 0.12+/-0.12 ng/mL, respectively (p=0.007). The pleural CRP levels were significantly higher in the exudate than the transudate, 2.83+/-3.31 mg/dL and 0.74+/-0.67 mg/dL, respectively (p<0.001). The pleural procalcitonin levels in the benign effusion were significantly higher than those in the malignant effusion, 1.15+/-3.82 ng/mL and 0.25+/-0.92 ng/mL, respectively (p=0.032). The pleural CRP levels were significantly higher in the benign effusion than in the malignant effusion, 3.68+/-3.78 mg/dL and 1.42+/-1.54 mg/dL, respectively (p<0.001). The pleural procalcitonin levels in the non-tuberculous effusion were significantly higher than those in the tuberculous effusion, 1.16+/-3.75 ng/mL and 0.13+/-0.37 ng/mL, respectively (p=0.008). CONCLUSION: Measuring the level of procalcitonin and CRP in the pleural fluid is helpful for differentiating between transudates and exudates. In addition, it is useful for differentiating between benign and malignant pleural effusions.
Subject(s)
Humans , Biopsy , C-Reactive Protein , Diagnosis , Empyema , Exudates and Transudates , Immunoassay , Inflammation , Pleural Effusion , Pleural Effusion, Malignant , Prospective Studies , Biomarkers, TumorABSTRACT
Lymphangiomas in the mediastinum are rare beningn tumors, characterized by proliferating lymphatic vessels. They are usually found in children and young adults, but rarely in older adults. Most are located in the neck, with less than 1 percent found in the mediastinum, with mediastinal lymphangiomas comprising 0.7-4.5 percent of all tumors in this location. They are often classified pathologically according to the size of the cystic spaces within them, as simple or capillary, cavernous and cystic, or just cystic, hygromas, Of the 3 types above, the cavernous type of mediastinal lymphangioma is very rare.We report a case of a mediastinal lymphangioma of the cavernous type that was confirmed from pathological findings, a CT and MRI scan.
Subject(s)
Adult , Child , Humans , Young Adult , Capillaries , Lymphangioma , Lymphangioma, Cystic , Lymphatic Vessels , Magnetic Resonance Imaging , Mediastinum , NeckABSTRACT
BACKGROUND: ADA is an enzyme found in most cells, and is involved in purine metabolism, but its chief role concerns the proliferation and differentiation of lymphocytes, especially T-lymphocytes. For that reason ADA has been looked on as a marker of cell-mediate immunity, which is th key mechanism of the tuberculous pleural effusion. Thus, the pleural fluid ADA activity is increased in the tuberculous pleural effusion.Age associated immune deline is characterized by decreases in both B and T-lymphocyte function and the former may be largely a result of the latter. Therefore, the epleural fluid ADA activity would be lower in old rather than in young, patients with tuberculous pleural effusion. We studied the relationship between age, and pleural fluid ADA activity, in patients with tuberculous pleural effusion. METHODS: In the 46 patients with tuberculous pleural effusion enroll in this study, the pleural fluid ADA activities were measured by means of an automated kinetic method. RESULTS: The mean age of the patients was 53.0+/-22.0 years, with a male to female ratio of 30 : 16. The patients were divided into two groups, young patients, regarded as or=65 years with 28 and 18 patients, respectively. The pleural fluid ADA activity in both groups show significant differences : 99.4+/- 22.6 IU/L(young patients) Vs. 75.8+/-30.9 IU/L(old patients)(p<0.05), but a negative correlation with age (r=-0.311, p<0.05). CONCLUSION: Although pleural fluid ADA activity was not adequately increase, tuberculous pleural effusion, in older patients, would have to be considered clinically suspicious tuberculous pleural effusion.
Subject(s)
Female , Humans , Male , Adenosine Deaminase , Adenosine , Lymphocytes , Metabolism , Pleural Effusion , T-LymphocytesABSTRACT
BACKGROUND: ADA is an enzyme found in most cells, and is involved in purine metabolism, but its chief role concerns the proliferation and differentiation of lymphocytes, especially T-lymphocytes. For that reason ADA has been looked on as a marker of cell-mediate immunity, which is th key mechanism of the tuberculous pleural effusion. Thus, the pleural fluid ADA activity is increased in the tuberculous pleural effusion.Age associated immune deline is characterized by decreases in both B and T-lymphocyte function and the former may be largely a result of the latter. Therefore, the epleural fluid ADA activity would be lower in old rather than in young, patients with tuberculous pleural effusion. We studied the relationship between age, and pleural fluid ADA activity, in patients with tuberculous pleural effusion. METHODS: In the 46 patients with tuberculous pleural effusion enroll in this study, the pleural fluid ADA activities were measured by means of an automated kinetic method. RESULTS: The mean age of the patients was 53.0+/-22.0 years, with a male to female ratio of 30 : 16. The patients were divided into two groups, young patients, regarded as or=65 years with 28 and 18 patients, respectively. The pleural fluid ADA activity in both groups show significant differences : 99.4+/- 22.6 IU/L(young patients) Vs. 75.8+/-30.9 IU/L(old patients)(p<0.05), but a negative correlation with age (r=-0.311, p<0.05). CONCLUSION: Although pleural fluid ADA activity was not adequately increase, tuberculous pleural effusion, in older patients, would have to be considered clinically suspicious tuberculous pleural effusion.
Subject(s)
Female , Humans , Male , Adenosine Deaminase , Adenosine , Lymphocytes , Metabolism , Pleural Effusion , T-LymphocytesABSTRACT
BACKGROUND: Coal workers' pneumoconiosis(CWP) is a fibrotic lung disease resulting from the chronic inhalation of coal dust. Various cytokines and growth factors secreted from macrophages and monocytes play a key r ole in the pathogenesis of penumoconiosis. The platelet-derived growth factor (PDGF)-BB and the insulin-like growth factor(IGF)-1 secreted from the macrophages and monocytes are believed to stimulate the accumulation of mesenchymal cells and fibrosis of the lower respiratory tract that is observed in fibrotic lung disease. The serum concentration of PDGF-BB and IGF-1 in 30 CWP patients and 10 healthy controls were measured in order to determine if PDGF-BB and IGF-1 can be used as sensitive biomarkers in CWP. METHODS: Serum was collected from 30 patients with CWP (13 with simple CWP and 17 with complicated CWP) and 10 healthy controls. The serum concentrations of PDGF-BB and IGF-1 were measured using ELISA (RandD system, Minneapolis, MN). RESULTS: The serum PDGF-BB concentration in patients with complicated CWP (10083.76+/-639.07 pg/ml) was significantly higher than in the patients with simple CWP(8493.88+/-848.51 pg/ml) and the healthy controls (3726.17+/-292.20pg/ml)(p0.05). CONCLUSIONS: These results show the important role of the PDGF-BB mediated pathways in the pathogenesis of CWP. These data suggests that the PDGF-BB serum concentration is a useful biomarkers of the fibrotic extent in CWP patients.
Subject(s)
Humans , Biomarkers , Coal , Cytokines , Dust , Enzyme-Linked Immunosorbent Assay , Fibrosis , Inhalation , Insulin-Like Growth Factor I , Intercellular Signaling Peptides and Proteins , Lung Diseases , Macrophages , Monocytes , Platelet-Derived Growth Factor , Pneumoconiosis , Pulmonary Fibrosis , Respiratory SystemABSTRACT
Primary lung cancer can metastasize by a direct local extension, hematogenous dessemination, and lymphatic spread. However, it less commonly metastasizes via a transbronchial invasion. A pproximately half of all patients with lung cancer have metastases at the initial presentation. Autopsy data showed that there are an average of 4.8 metastatic sites. The most common sites for metastases include the lymph nodes, liver, adrenal gland, bone, and brain. However, clinically significant metastases isolated in the small bowel seldom occur. Here we report a case of lung cancer with a small bowel metastasis.
Subject(s)
Humans , Adrenal Glands , Autopsy , Brain , Liver , Lung Neoplasms , Lung , Lymph Nodes , Neoplasm MetastasisABSTRACT
The Os odontoideum is a developmental anomaly of the axis in which the odontoid process is divided transversely. The Atlanto-axial dislocation due to Os odontoideum is presented. At first, we have performed the posterior atlanto-axial fusion with wire fixation. But the posterior fusion failed in realignment and did not adequately decompress the deformed cord by encroachment on its ventral surface. Next time, we have experienced further improvement following transoral decompression and anterior fusion.
Subject(s)
Axis, Cervical Vertebra , Decompression , Joint Dislocations , Odontoid ProcessABSTRACT
Spontaneous thoracic epidural hematoma occur rarely. We present a case of spontaneous thoracic epidural hematoma without any identified etiology and discuss the symptoms, signs and pathophysiology of this disorder. Early diagnosis and treatment by surgery can result in good recovery.
Subject(s)
Early Diagnosis , HematomaABSTRACT
Intracerebral metastatic choriocarcinoma is characterized by acute apoplexy bue to vascular invasion with tumor emboli. We experienced 3 cases of intracerebral metastatic choriocarcinoma having such a apoplexy and rebleeding.
Subject(s)
Female , Pregnancy , Choriocarcinoma , StrokeABSTRACT
We have experienced 480 cases of Cerebrovascular Disorder confirmed by C. T. Brain scan, who admitted to the Kyung hee Medical Center from January 1979 to December 1980. The authors have analyzed the clinical aspects of Cerebrovascular Disorder. The following results are obtained. 1) Intracranial hemorrhage group is more commoner than occlusive group. The sixth decade is most frequently involved. Male is more affected. 2) Headache is most frequent initial symptom and next sequence is paresis. 3) The prognosis is correlated with the initial consciousness level, initial CSF pressure and hematoma volume. 4) In the intracranial hemorrhage group, the prognosis is somewhat better in the operative cases than in the non-operative cases.
Subject(s)
Humans , Male , Brain , Cerebrovascular Disorders , Consciousness , Headache , Hematoma , Intracranial Hemorrhages , Paresis , Prognosis , Subarachnoid HemorrhageABSTRACT
Solitary intramedullary hemangioblastoma of the high cervical cord is rare. The incidence of spinal cord hemangioblastomas varies from 1.6% to 3% of primary spinal cord tumors. The case report dealt with a small solitary hemangioblastoma of 0.4cm in diameter arising in the intramedullary portion of the high cervical cord. Computerized axial tomograms of the brain including the cervical cord could not detect the tumor and cervical myelograms also failed to identify the mass. However, the vertebral angiography revealed a vascular nodule with abnormally dilated feeding artery arising from the right vertebral artery. The tumor was excised in toto from the surrounding medullary tissue without difficulties. The postoperative course of the patient had been uneventful. The possibility of missing such a small tumor like this one was emphasized.
Subject(s)
Humans , Angiography , Arteries , Brain , Hemangioblastoma , Incidence , Spinal Cord , Spinal Cord Neoplasms , Vertebral ArteryABSTRACT
We experienced the unusual C.T. finding of meningioma recently. Classical C.T. finding of meningioma reveals found homogenous high density or isodensity in the plain C.T. and homogenous marked enhancement in the postinfusion C.T. But, some of meningioma demonstrates atypical features such as irregular areas of nonenhancing mass, irregular ill-defined enhancing mass with large area of peritumoral edema, low density area within the mass representing necrosis and cystic change. C.T. finding that we experienced revealed ring-formed high density in the plain C.T. and homogenous strong enhancement in the postinfusion C.T.