Difference in Infarct Volume and Initial Clinical Severity between Stroke Patient with Patent Foramen Ovale and Atrial Fibrillation / 대한뇌졸중학회지

BACKGROUND: Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF. METHODS: We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS) on admission were compared between patients with AF and PFO. RESULTS: From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P<0.01). A probable cardiac embolism, radiologically defined as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P<0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic deficit (NIHSS< or =3) after adjusting age, sex and previous stroke history. CONCLUSION: These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classified as cardioembolism.

Behavioral and Psychological Symptoms in Patients with Parkinson's Disease According to Cognitive Function

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor symptoms such as cognitive impairment and neuropsychiatric symptoms. The aim of this study was to investigate the spectrum of neuropsychiatric symptoms in PD according to cognitive function. METHODS: One hundred twenty seven patients with PD were consecutively recruited. They had undergone an intensive interview with a neurologist and the Seoul Neuropsychological Screening Battery-dementia version, and were divided into three groups: 27 patients in PD with normal cognition (PDNC), 57 in PD with mild cognitive impairment (PDMCI), and 43 in PD with Dementia (PDD). Forty five healthy controls without memory complaints were also recruited. The caregivers of all participants administered the Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI). RESULTS: There were significant differences in the CGA-NPI score (22.8+/-20.9 vs. 6.4+/-10.1 vs. 1.7+/-3.9 vs. 1.0+/-1.6, p<0.001), and the prevalence of neuropsychiatric symptoms (100% vs. 64.9% vs. 37.0% vs. 44.4%, p<0.001) among PDD, PDMCI, PDNC and control groups. Depression was the most common symptom (43.3%), followed by anxiety (31.5%), apathy (26.8%), and night-time behavior (26.8%) in all PD patients. Delusion, hallucination, and aberrant motor behavior were observed frequently in PDD, but were rare in PDMCI. CONCLUSIONS: Depression was the most common neuropsychiatric symptom in PD. The presence of delusion, hallucination, or aberrant motor behavior may suggest PDD. The neuropsychiatric symptoms were not prevalent in PD with normal cognition.

Cerebral Venous Thrombosis Presenting as Isolated Subarachnoid Hemorrhage / 대한뇌졸중학회지

Cerebral venous thrombosis (CVT) rarely presents with cortical subarachnoid hemorrhage. A 54 year-old woman complained of intractable headache. Brain MR scan showed subarachnoid hemorrhage in the right parietal sulci on Fluid-Attenuated Inversion Recovery image. The venous phase of digital subtraction angiography demonstrated the thrombus and venous congestion in superior sagittal sinus and vein of Trolad. After 3 days of anticoagulation therapy, the symptoms disappeared.

The Effect of Cognitive Training in Patients with Mild Cognitive Impairment and Early Alzheimer's Disease: A Preliminary Study

BACKGROUND AND PURPOSE: The objective of this study was to determine the benefits of cognitive training in patients with amnestic mild cognitive impairment (aMCI) and those with early Alzheimer's disease (AD). METHODS: Eleven patients with aMCI and nine with early AD (stage 4 on the Global Deterioration Scale) participated in this study. Six participants with aMCI and six with AD were allocated to the cognitive training group, while five participants with aMCI and three with AD were allocated to a wait-list control group. Multicomponent cognitive training was administered in 18 weekly, individual sessions. Outcome measures were undertaken at baseline, and at 2 weeks and 3 months of follow-up. RESULTS: In the trained MCI group, there were significant improvements in the delayed-recall scores on the Seoul Verbal Learning Test at both the 2-week and 3-month follow-ups compared with baseline (baseline, 1.6+/-1.5; 2 weeks, 4.4+/-1.5, p=0.04; 3 months, 4.6+/-2.3, p=0.04). The phonemic fluency scores (1.0+/-0.8 vs. 5.0+/-1.8, p=0.07) and Korean Mini-Mental State Examination scores (18.8+/-0.5 vs. 23.8+/-2.2, p=0.07) also showed a tendency toward improvement at the 2-week follow-up compared to baseline in the trained AD group. CONCLUSIONS: This study provides evidence of the effectiveness of cognitive training in aMCI and early AD. The efficacy of cognitive training programs remains to be verified in studies with larger samples and a randomized design.

Cerebral Venous Thrombosis in the Inferior Sagittal Sinus

No abstract available.

Survival Analysis of Hemodialysis Patients: A Single Center Study / 대한신장학회잡지

PURPOSE: In order to investigate the survival rate, causes of death, and the predictors of death in hemodialysis patients with chronic renal failure. METHODS: Among the 3,462 patients who started hemodialysis in Asan Medical Center between May 1989 and December 1999, we selected 674 patients who were closely observed at least for 3 months since they began hemodialysis as an initial replacement therapy for chronic renal failure. Demographic and clinical characteristics, including diabetes mellitus, hepatitis viral marker, and laboratory findings at the beginning of hemodialysis were retrospectively analyzed RESULTS: The mean age of the patients was 51.0+/-14.8 years, and their sex ratio was 1.4:1(M:F). The proportion of patients with diabetic nephropathy was 34.4%. The mean follow-up period was 34.2+/-28.1 months and 117 patients died(17%). The greatest number of patients were found to have died of cardiac problems(23%), followed by cerebrovascular disease(16.2%), infection(13.7%) and malignant disease(11.1%). The survival rate of the 674 patients was found to range from 1 to 10 years:96% at 1 year, 88% at 2, 73% at 5, and 54% at 10 years. In order to determine the independent predictors of death, we used Cox proportional hazards model. The predictors of death in hemodialysis patients were found to be (i) male(Relative risk(RR)=1.46, p=0.06), (ii) people over 60 years of age(RR=1.54, p=0.03), diabetes mellitus(RR=1.45, p=0.06), and (iii) low level of serum creatinine(RR=0.65, p < 0.001). CONCLUSION: Cardiovascular disease and infectious diseases were important causes of death in hemodialysis patients. Old age and low serum creatinine at the beginning of hemodialysis were significant predictors of death.

C-reactive Protein, Coronary Heart Disease, and Mortality in CAPD Patients / 대한신장학회잡지

BACKGROUND: Atherosclerotic vascular disease is major cause of morbidity and mortality in dialysis patients. C-reactive protein(CRP) as a marker of inflammmation appears to be clinically useful in prediction of coronary heart disease and mortality. This study is designed to test whether plasma concentration of CRP correlates with coronary heart disease and mortality in CAPD patients. METHODS: A total of 137 end-stage-renal disease patients undergoing CAPD were included. The measurement of baseline CRP and stress thallium SPECT were performed in all patients. Patients were followed prospectively from initiation of dialysis to June 1999 for analysis of survival rate and cause of death. Coronary angiography performed in 16 of 32 patients showed all positive results. RESULTS: 32 patients showed positive results in thallium SPECT. The baseline CRP concentration were higher among patients with positive results in thallium SPECT than those with negative results(1.05 g/L vs 1.30mg/dL, p<0.001). The survival rate was significantly lower in lower CRP group than higher CRP group (44months vs 26 months, p<0.001). However, There was no difference in cause of death according to serum CRP level. Death from cardiac cause is significantly higher among patients with positive thallium SPECT than negative results. The most common cause of death are, in descending order of frequency, cardiac disease including acute MI, sepsis, cerebrovascular disease. CONCLUSION: The baseline level of inflammation as assessed by the plasma concentration of CRP independently predicts the risk of coronary heart disease and survival in CAPD patients.

Sociodemographic Characteristics, Attitudes and Personal Values of the Applicants at a College of Medicine of University / 한국의학교육

Group characteristics(sociodemographic characteristics, attitudes and personal values) of the successful applicants of 1997 at Ulsan College of Medicine were compared with those of the unsuccessful ones. The principal data were the responses of pre-entrance examination questionnaire survey were administered to all applicants. The results were presented the headings of 1) sociodemographic characteristics, 2) financial status, 3) goals of college life, 4) reasons to choose university of Ulsan College of Medicine, 5) personal values. The results of the present study may serve as the basic data to make comprehensive and systematic plans for the adjustment of medical students in the future.

Reviews on the Psychological Variables Concerning the Successful Adjustment in Medical Colleges / 한국의학교육

In this article, we critically reviewed various literatures on stress and adjustment in medical schools as a preliminary work for the future empirical study. We adopted Biopsychosocial Model as the frame of reference, which considers not only the relationship between stressor and psychological distress, but also their interaction with moderating variables such as psychosocial resources and vulnerabilities. According to the model, three important aspects of medical school stress were reviewed: 1) the types of medical school stresses, 2) the adverse effects of stressors on the adjustment such as depression, anxiety, physical symptoms, drug abuse, eating problem, attrition, change of attitude and personality, etc, 3) the moderating effects of various vulnerabilities and resources including Type A behavior pattern, masculinity/femininity, locus of control, optimism, anger expression, coping style, social support, and study skills on the suppression or development of psychological distress. Investigating the moderating variables in particular may have great clinical implications since these variables are closely related to the psychological factors concerning successful adjustment in medical school. Conclusions drawn from this review suggests several directions of future research. First, a comprehensive study which covers the whole process of medical school stress is recommended. Longitudinal design will be more suitable for dealing with the developmental features of medical education. Finally, the severity of medical school stress must be compared with the stress of general colleges and other professional graduate schools. This article is expected to provide some theoretical basis for future studies regarding the successful adjustment in the medical school, the development of preventive intervention programs and the reform of medical education systems.

Usefulness of Intravenous Iron Supplement During Recombinant Human Erythropoietin(rHuEPO) Therapy in Hemodialysis(HD) Patients / 대한신장학회잡지

Compared with iron dextran, iron chondroitin sulfate(ICS) is much cheaper and has better bioavailability. To evaluate the efficacy and safety of ICS in maintenance HD patients, i.v. ICS was given to 37 HD patients [20 M, 17 F, median age 51 years, median duration of HD 21 months] whose ferritin(Fer)or=100microgram/L and TFS>or=20% [Group II, 8 M, 7 F]. The patients had taken oral iron [227+/-73mg/day(mean+/-SD)] before this study. All patients received 120mg i.v. ICS weekly for 1 month. Then, ICS dosage was adjusted to 40-120mg/week depending on Hb, Fer and TFS in the following 3 months. Hb, Fer, TFS, rHuEPO dose and side effects were monitored monthly. The results were as follows : 1) I.v. iron therapy produced a significant rise in Hb(8.3+/-0.9g/dL to 9.7+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(95+/-50U/kg/wk to 69+/-28U/kg/wk; P<0.05), a significant increase in serum ferritin levels(162+/-149microgram/L to 472+/-255microgram/L; P<0.01) and TFS(24+/-13% to 41+/-18%; P<0.05). 2) In group 1, i.v. iron therapy produced a significant rise in Hb(8.5+/-1.1g/dL to 9.9+/-0.9g/dL; P< 0.01), a significant reduction in rHuEPO dose(87+/-45U/kg/wk to 69+/-27U/kg/wk; P<0.05), increased serum ferritin levels(90+/-48microgram/L to 379+/-186microgram/L; P<0.01) and TFS(18+/-9% to 36+/-16%; P<0.05). 3) In group 2, i.v. iron therapy produced a significant rise in Hb(8.1+/-0.6g/dL to 9.3+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(108+/-55U/kg/ wk to 69+/-31U/kg/wk; P<0.05) and increased serum ferritin levels(274+/-185microgram/L to 602+/-287microgram/L; P< 0.01) with a tendency of increase in TFS(35+/-13% to 41+/-18%; P=0.06). 4) No significant side effect was observed. 5) An annual cost reduction of 221 US dollars per patient was expected. In conclusion, ICS is an effective and safe intravenous iron preparation in HD patients.

Mission and Roles of Medical School Faculty / 한국의학교육

No abstract available.

Cholesterol embolism associated with acute renal failure after coronary angiography / 대한신장학회잡지

No abstract available.