The Quantitative 18-fluorodeoxyglucose PET Study in the Differential Diagnosis between Idiopathic Parkinson's Disease and Multiple System Atrophy

BACKGROUND: Overlapping clinical features of idiopathic Parkinson's disease (IPD) and multiple system atrophy (MSA) make it difficult to conduct an accurate differential diagnosis. We performed a quantitative F18- fluorodeoxyglucose PET (FDG PET) and measured the striatal and cerebellar glucose metabolism to evaluate the efficacy of a FDG PET study in the differential diagnosis between IPD and MSA. METHODS: This study included 19 patients with IPD, 28 patients with MSA (MSA-P : MSA-C = 19 : 9) and 12 age matched normal controls. A FDG PET study was performed in all subjects and the original PET image was corrected with the radioactivity curve obtained by repetitive sampling of the radial arterial blood. RESULTS: The measurements of striatal and cerebellar glucose metabolisms of the patients with MSA-P were significantly lower than those of the patients with IPD (P<0.001). However, the measurement of the caudate nucleus provided the most reliable clue for the differential diagnosis between IPD and MSA-P (sensitivity 94.7% and specificity 94.7%). In the patients with MSA-C, the glucose metabolism of the cerebellar vermis (P<0.001), cerebellar cortex (P<0.001) and putamen (P<0.05) was significantly lower than those of the patients with IPD. CONCLUSIONS: Quantitative FDG PET is a useful and reliable method in making a differential diagnosis between IPD and MSA.

QTc Interval Prolongation with Increasing Body Mass Index

BACKGROUND: Prolongation of the QTc interval is a risk factor for ventricular tachycardia, ventricular fibrillation, especially torsades de pointes, and sudden death. It is associated with increasing age, female sex, some of antiarrhythmic drugs, tricyclic antidepressants, and conditions such as hypokalemia, hypothermia, subarachnoid hemorrhage, congenital long QT syndrome. Earlier studies reported lengthening of the QTc interval with increasing body mass index (BMI) and intra-abdominal fat. But no such reports exist in Korea. Therefore, we determined the relationship between BMI and the QTc interval. METHODS: The study population consisted of 372 persons who undertook periodic health examination in a university hospital between September and December 1998. BMI and standard 12-lead electrocardiogram were measured in all subjects. Excluding 4 patients who had arrhythmia where QTc interval could not be calculated, the QT interval was measured in the electrocardiogram of 368 subjects. The QT interval was measured in the leads that showed the longest interval for three consecutive beats and then were averaged. Correlation between the calculated QTc interval and BMI was examined. The QTc interval difference according to sex and obesity was also analyzed. RESULTS: Among 368 subjects, there were 197 men (54%) and 171 women (46%). The mean ages were 44.5 years for men and 47.6 for women. The BMI was 23.8 3.13 (mean SD). Obese subjects with BMI above 27 kg/m2 totalled 61 (17%), including 31 men and 30 women. The QTc interval was 399 25 msec (mean SD), and the subjects showed prolonged QTc intervals of 24 (12 men and 12 women). There was a statistically significant correlation between BMI and QTc interval (r=0.135, P=0.0094), and the obese subjects were found to have a longer QTc interval than the nonobese controls. Women also had a longer QTc interval than men. CONCLUSION: There was a significant correlation between BMI and QTc interval, and longer QTc interval was observed in obese patients. The QTc interval should be considered when analyzing electrocardiogram of obese patients.

Causes and characteristics of the chest pain(in the chest-pain clinic)

BACKGROUND: Ischemic heart disease is the most important cause of the chest pain, and its frequency is increasing enormously. The purpose of this study is to find out the way of early detection and/or ruling out the cardiogenic chest pain by history taking. METHODS: From July 1996 to December 1999, 248 patients visited the chest-pain clinic and took the questionnaire about characteristics of the chest pain. And we found out the diagnosis that caused the chest pain. 46 patients of them were excluded because of the unreliable responses or uncertain diagnosis. So, we compared the characteristics of the chest pain with causes for 202 patients. RESULTS: The sex ratio of patients was 1.43:1(male:female). The average age was 41.8+/-14.0 for male and 47.3+/-14.8 for female. The causes of the chest pain were cardiogenic(23.2%), musculo-skeletal(19.3%), psychogenic (14.8%), gastrointestinal(12.4%), and pulmonary disease(6.9%). Patients with the past history of diabetes, hypertension, alcohol intake, or angina were more likely to have cardiac disease. Choking (O.R=2.19, C.I.=1.08-4.44), splitting(O.R=3.38, C.I.=1.24-9.21), or exploding pain (O.R=2.65, C.I=1.02-6.88) was more likely to be originated from cardiac disease. And patients with cardiogenic chest pain aggravated their symptoms by climbing the stairs(O.R=3.47, C.I= 1.52-7.90). But, pricking pain(O.R=0.18, C.I.= 0.04,-0.82) or chest pain associated with dyspepsia(O.R.=0.16, C.I.=0.04-0.69) was less likely to be originated from cardiac disease. CONCLUSION: For detection and/or ruling out the cardiogenic chest pain, we have to check out characteristics of the pain, but also factors that associated with the pain or aggravating the pain.

Age grouping patterns and guideline age of the elderly in Korean Medical Journals

BACKGROUND: As the elderly population grows and increasing average life expectancy, medical needs and utilization by elderly people are rapid increase in recent years. It is thus essential that elderly people are included in clinical studies. There are also needed the standardization of age grouping and guideline of the elderly for the purpose of relative review between studies. And a study must include what age was used as a cut off value. So we set out to discover age grouping, cut off ages and guideline age of the elderly in two major Korean medical journals. METHODS: We examined all original research papers in all the issues of the Korean Journal of Medicine (KJM), and the Journal of The Korean Surgical Society (JKSS) between January 1995 and December 1997. We excluded animal works and papers concerned with special age (children, soldiers). Of the remaining 931 (386 KJM/545 JKSS) papers, we reviewed how many papers included elderly people in them, age grouping and regularity, age group intervals, cut off age, and of the specific to the elderly papers, what age was used as guideline age of the elderly. RESULTS: Of the reviewed 931 papers, included above 60-year were 701 (75.3%), excluded were 166 (17.8%), and no age limit was set in 64 (6.9%) papers. Of the 701 papers that included above 60 years, no age grouping were 349 (49.8%), and 352 (50.2%) had age grouping. Among them, 341 papers used regular intervals, while 11 papers used irregular intervals. Of the 341 regular age interval papers, five year interval were 4, ten year were 322, fifteen year were 2, and twenty year were 13. The cut off age as a specific value were 118, and cut off as a group of ages were 223. Ten papers were specifically about elderly people. Of these papers, the guidelines of the elderly were 60-year in 6, and 65-year in 4 papers. CONCLUSION: Many Korean medical papers included above 60-year people. But near half of them had no age grouping, and no age limit sets were 6.9%. And there were mixed use of 60 and 65 years for guideline of the elderly. So more elderly people should be included in future clinical studies. The standardization of age grouping and guideline of the elderly are also needed.

Segmental short transpedicular fixation of unstable thoracic lumbar vertebral fractures / 대한정형외과학회잡지

No abstract available.

A Clinical Study of Anatomic Position Change on the Intra / 대한정형외과학회잡지

Despite a variable degree of comminution, the intra-articular fracture of the distal radius comprises four basic fragments : 1.Radial shaft; 2.Radial styloid; 3.Dorsal medial fragment; 4.Palmar medial fragment. For the period of 3 years from May 1984 to May 1987, 26 patients who had been treated for intra-articular fracture of the distal radius by various methods at the Department of Orthopedic Surgery, Kang Nam Sacred Heart Hospital, Hallym College are presented. According to the objective criteria of Scheck(18) used for calculating the degree of anatomic position change, the result obtained were as follows : 1. The most common fracture type was Type II by Melon(6) classification. 2. The average age of patients was 34 years old. 3. We agree that the accurate anatomic reduction with internal fixation assures better results in the distal radius intra-articular fracture. 4. CT scan was necessary for the accurate diagnosis of articular surface destruction. 5. Accurate relationship of the anatomic and functional result could be analyzed by Scheck(18) and Melon(6) concepts.