Effect of laser-assisted multi-point zona thinning on development and hatching of cleavage embryos in mice / 대한생식의학회지

OBJECTIVE: This study aimed to examine the effect of laser-assisted zona thinning (LAZT) at one or four-points on the blastocyst formation and hatching process in mice with respect to female age. METHODS: Eight-cell or morula embryos collected from superovulated C57BL female mice with different ages (6-11 and 28-31 weeks) were treated with LAZT at one-point (LAZT1) or four-points (LAZT4). The zona pellucida was thinned to more than 70% of its initial thickness by making two holes of 15-20 microm. RESULTS: In the young mice, LAZT resulted in a significant increase in early hatching and hatching rates compared to the control group (p<0.05). However, in the old mice, LAZT significantly increased blastocyst formation as well as early hatching and hatching compared to the controls (p<0.05). These effects were more remarkable in LAZT4 than in LAZT1 and in aged mice than in young ones. CONCLUSION: These results show that multi-point LAZT leads to a significant improvement of blastocyst formation and hatching in mice compared to controls.

Weekend Admission in Patients with Acute Ischemic Stroke Is Not Associated with Poor Functional Outcome than Weekday Admission

BACKGROUND AND PURPOSE: Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea. METHODS: The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions. RESULTS: On weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis. CONCLUSIONS: Weekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.

Acute Stroke in Patients With Isolated Vertigo / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Patients with isolated vertigo could have central or peripheral vestibular disorders. Although some differential points exist between the two conditions, sometimes it is not easy to differentiate central vertigo from that of peripheral vestibular origin, especially in patients with isolated vertigo. We performed this study to determine the frequency of acute infarction and predictors of vertigo associated with stroke in isolated spontaneous vertigo. MATERIALS AND METHODS: We prospectively evaluated 185 consecutive patients who were admitted to neurology department with acute isolated vertigo, after excluding the patients with benign paroxysmal positioning vertigo. Diffusion-weighted MRI (DWI) was obtained in 161 (87.0%) patients. Demographics, stroke risk factors, associated symptoms and signs were reviewed. Also, the locations and vascular territories of the lesions on DWI were investigated. RESULTS: Twenty three (14.3%) patients had acute infarction on DWI. Old age and male sex were the predictors of stroke using multivariate analysis (p=0.03 and 0.02). The lesions were located in the cerebellum in 17 patients, medulla in four, and pons in another four. Cerebellar lesions were in the territory of the posterior inferior cerebellar artery in all patients. CONCLUSION: Isolated spontaneous vertigo may develop in posterior circulation stroke, especially in men of old age. The possibility of central origin should be considered in patients with isolated vertigo and DWI might be a good diagnostic tool.

Eating Seizures in a Patient With Alzheimer's Disease

No abstract available.

White Matter Abnormalities of Migraine and Tension Type Headache in Young Patients Without Vascular Risk Factors

BACKGROUND: White-matter abnormalities (WMAs) are frequently encountered on MRI conducted for the diagnosis of headache. Although many studies have suggested an association between migraine and stroke or WMAs, no definite conclusions can be drawn from these data because of confounding factors. The purpose of our study was thus to determine whether the incidence and location of WMAs in migraine differ from those in tension-type headache. METHODS: The MRI findings of 180 patients (130 with migraine and 50 with tension-type headache) under 45 years of age without vascular risk factors were reviewed. MRI findings were reviewed with respect to focal white-matter hyperintensities on fluid-attenuated inversion recovery. The frequency, location, and volume of the abnormalities were measured. RESULTS: WMAs were observed in 24% of patients with migraine and 28% of those with tension-type headache (p=0.71). The number and volume of abnormalities in both groups were not different. WMAs were most frequently located in the subcortical area in both groups. The age of patients with WMAs was older than patients without abnormalities (36.4+/-7.2 vs 29.6+/-9.2, mean+/-SD; p<0.01). There was a positive correlation between patient age and the volume of WMAs (p=0.04). In the migraine group, WMAs were seen in 21% of patients with migraine without aura and in 60% of those with migraine with aura (p=0.01). CONCLUSIONS: Although the characteristics of WMAs were not different between patients with migraine and those with tension-type headache, the incidence of WMAs was significantly higher in migraine with aura. This may be extrapolated to an increased risk for stroke in patients with migraine with aura, but not in those with migraine without aura.

Alcohol Related Seizures in Chronic Alcoholics / 대한간질학회지

PURPOSE: Alcohol related seizures (ARS) are common problems in community. We reviewed the clinical characteristics of ARS in chronic alcoholics and evaluated the predictors of delirium tremens and recurrence of seizures. METHODS: We thoroughly reviewed all medical records of patients with alcohol related seizures at admission and some outpatient records for follow-up data. For the patients who had been lost during follow-up, telephone interviews were performed. We described the clinical characteristics of ARS during admission and analyzed the correlation between initial findings of ARS. RESULTS: Forty eight patients with ARS were admitted and followup data were available in 33 patients by out-patient records or telephone interviews. Forty-four patients were male and the mean age was 47.4+/-10.4 years old. Nine out of 33 patients became completely abstinent after discharge. Ten out of 24 current drinkers developed recurrent seizures and 20 out of 48 patients developed delirium tremens (DT) during admission. The number of seizures and age ofpatients were significantly related with DT. Patients with much weekly- consumption of alcohol were prone to develop recurrent seizures. CONCLUSIONS:These results suggest that careful attention should be paid to the patients with older age and multiple seizures at each event about the development of DT and to the patients with much weekly-consumption of alcohol about the recurrence of seizures during follow-up.

Aggressive Glucose Control for Acute Ischemic Stroke Patients by Insulin Infusion

BACKGROUND AND PURPOSE: Hyperglycemia after acute ischemic stroke (AIS) is associated with poor outcomes. However, there is no consensus as to the optimal method for glycemic control. We designed an insulin infusion protocol for aggressive glucose control and investigated its efficacy and safety. METHODS: We applied our protocol to patients within 48 hours after AIS or transient ischemic attack (TIA) with an initial capillary glucose level of between 100 and 399 mg/dL (5.6-22.2 mmol/L). An insulin solution comprising 40 or 50 U of human regular insulin in 500 mL of 5% dextrose was administered for 24 hours. Capillary glucose was measured every 2 hours and the infusion rate was adjusted according to a nomogram with a target range of 80-129 mg/dL (4.4-7.2 mmol/L). Changes in glucose and overall glucose levels during insulin infusion were analyzed according to the presence of diabetes or admission hyperglycemia (admission glucose >139 mg/dL or 7.7 mmol/L) by the generalized estimating equation method. RESULTS: The study cohort comprised 115 consecutive patients. Glucose was significantly lowered from 160+/-57 mg/dL (8.9+/-3.2 mmol/L) at admission to 93+/-28 mg/dL (5.2+/-1.6 mmol/L) during insulin infusion (p<0.05). Laboratory hypoglycemia (capillary glucose <80 mg/dL or 4.4 mmol/L) occurred in 91 (71%) patients, 11 (10%) of whom had symptomatic hypoglycemia. Although glucose levels were significantly lowered and maintained within the target range in all patients, overall glucose levels were significantly higher in patients with diabetes or hyperglycemia (p<0.05). CONCLUSIONS: Our insulin-infusion protocol was effective in glycemic control for patients with AIS or TIA. Further modification is needed to improve the efficacy and safety of this procedure, and tailored intervention should be considered according to glycemic status.

Polyneuropathy Associated with IgA Paraproteinemia and Amyloidosis: A Case Report and Literature Review

Paraproteinemia potentially causes peripheral neuropathy via an unknown underlying pathogenetic mechanism. We report a case of pathologically proven amyloid neuropathy with AL amyloidosis with an IgA kappa light chain, which was initially diagnosed as neuropathy associated with monoclonal gammopathy of undetermined significance. This case indicates that in cases of neuropathy with paraproteinemia, the other potential causes should be excluded by appropriate means, especially pathological evaluations.

Impact of Intracranial Cerebral Atherosclerosis on the Long-term Mortality after Ischemic Stroke

BACKGROUND: Intracranial cerebral atherosclerosis (ICAS) is an important cause of stroke, but it is not well-known whether and how much it contributes to the long-term prognosis of stroke patients. The purpose of this study was to elucidate the impact of ICAS on the long-term mortality of patients with acute ischemic stroke. METHODS: From November 1998 to December 2002, a consecutive series of 1306 patients who were hospitalized due to acute ischemic stroke were listed in the stroke registry. Among them, 946 patients who underwent brain MRI and MRA were selected and their vital status was identified by the National Death certificates. RESULTS: Among 946 subjects, 624 (65.9%) had ICAS, while 106 (11.2%) had extracranial carotid atherosclerosis (ECAS). During a period of 59 months (27+/-16 months), 220 patients died. The 30-day, 1-year, 2-year, 3-year, and 4-year mortalities were 2.8%, 14.5%, 22.9%, 27.8% and 35.1% for those with ICAS (N=624); whereas 2.2%, 7.7%, 13.2%, 15.4% and 19.2% for those without ICAS (N=322) (p=0.0001 on log rank test). Crude hazard ratio (HR) of ICAS was 1.9 (95% confidence interval, 1.39 to 2.62), but adjusted HR of ICAS was 1.16 (0.82 to 1.62). The number of intracranial arteries with atherosclerosis and the existence of symptomatic ICAS were also considered. Both of them were significant predictors of the long-term mortality in crude analyses, but lost their significance after adjustments. CONCLUSIONS: This study failed to prove the independent contribution of ICAS to the mortality of patients with acute ischemic stroke.

Usefulness of a Weighted-based, Patient-Specific Nomogram for Intravenous Heparin Therapy in Ischemic Stroke Patients

BACKGROUND: Despite the lack of supporting evidence, intravenous heparin is still given frequently in the treatment of cerebral ischemia. However, there is only one study for the use of heparin nomogram in ischemic stroke or TIA. We evaluated the usefulness of a patient-specific, as well as weight-based, nomogram for the intravenous heparin in patients with ischemic stroke or TIA. METHODS: From Sep. 2004 to Sep. 2005, we recruited ischemic stroke patients treated according to the specifically designed heparin nomogram. The therapeutic range (TR) of activated partial thromboplastin time (aPTT) and dose adjustment were specified as a ratio of each patient's baseline aPTT. The first time to achieve TR (TR-time), to exceed therapeutic threshold (TE-time) and the fraction of time in TR (total time in TR/total time of heparin use, %) were analyzed. RESULTS: A total of 45 patients were included. The mean fraction of time in TR was 72.7+/-14.4%. Although TR-time and TE-time did not differ according to the use of bolus injection, the fraction of first aPTT at 6 hours after start of infusion in TR was higher with bolus than without bolus (84.8 vs. 58.3, p<0.05). CONCLUSIONS: Our nomogram could achieve and maintain therapeutic heparin anticoagulation effectively. Initial bolus injection may be better to achieve therapeutic anticoagulation more rapidly.

Guillian-Barre Syndrome after Preceding Shingles

Guillain-Barre Syndrome (GBS) has been known to be preceded by various infections such as Campylobacter jejuni, cytomegalovirus, and so on. We have experienced a case of GBS after a preceding herpes zoster, which was complicated by GBS, which is rare. Some circumstantial and experimental clues suggest a possible causal relationship between those two. Here we report the case along with a literature review.

Analysis of 10,811 Cases with Acute Ischemic Stroke from Korean Stroke Registry: Hospital-Based Multicenter Prospective Registration Study

BACKGROUND: Although several hospital-based stroke studies were published, there has not been any reliable data representing the clinical characteristics of stroke in Korea. We analyzed the clinical characteristics of patients with ischemic stroke registered in the Korean Stroke Registry (KSR), which is the largest prospective hospital-based nation-wide stroke registry in Korea. METHODS: The KSR provided standardized protocols for collecting data, which includes the data of demographics, subtypes of stroke, risk factors, and neurological outcome at discharge. The brain imaging studies, including CT or MRI, were performed in all cases. RESULTS: KSR registered 10,811 patients of acute ischemic stroke between Nov. 2002 and Jun. 2004. The large-artery atherosclerosis was the most common subtype (37.3%), followed by small vessel occlusion (30.8%). Hypertension (65.4%) was the most common risk factor, followed by smoking (34.5%) and diabetes (28.3%). Although most of the hypertensive and diabetic patients had been diagnosed before the stroke, less than 45.4% and 32.5% of them were under regular control. The steno-occlusive lesion of extracranial carotid artery was only 29.3% and the ratio of intra- to extracranial artery disease was more than 2 in KSR. Only 20.5% of patients were admitted within 3 hours after stroke onset and 2.1% were treated with intravenous thrombolysis. In-hospital case-fatality was 5.2%, which is relatively comparable to those of previous studies. CONCLUSIONS: The KSR provided informative data in understanding the clinical characteristics of ischemic stroke in Korea. Further analysis of KSR will facilitate clinical trials and development of guidelines for the management of stroke patients.

The Effectiveness of Physical Therapy for the Horizontal Canal Cupulolithiasis

BACKGROUND & OBJECTIVES: Recently many reports suggest the horizontal canal benign paroxysmal positional vertigo (h-BPPV) is not rare. However there have been few reports on physical therapy for horizontal canal cupulolithiasis, while horizontal canal canalithiasis has a relatively well defined and effective therapy. To evaluate the efficacy of different methods of treating horizontal canal cupulolithiasis, we conducted prospective study. METHODS: We enrolled 104 consecutive patients who were diagnosed with h-BPPV. During that period, patients with posterior canal BPPV numbered 112. Patients with h-BPPV were diagnosed when lateral head rotation in the supine position resulted in geotropic or apogeotropic bilateral horizontal nystagmus. In patients presenting with apogeotropic variant (n=40), following maneuvers was performed sequentially. First of all, we performed head shaking and applied vibrator to the mastoid bone to detach otolith from cupula. If they failed to detach otolith from cupula, we performed barbecue rotation and forced prolonged position (FPP). The treatment outcome was considered as responsive when, immediately after each physical therapy, nystagmus shifted from apogeotropic to geotropic or no nystagmus was elicited by provocation test and symptoms of positional vertigo abated. RESULTS: There were 27 women and 13 men from ages 30 to 80 (mean 55) years. The average duration of symptoms before intervention was 0 to 12 (mean 0.6) days. In 4 cases, symptoms resolved spontaneously after provocation test. Of the 36 patients treated with headshaking, 6 were responsive. Of the 30 patients treated with vibrator after failure of head shaking, only 1 were responsive. In the barbecue rotation, none obtained relief after barbecue rotation. Of the 9 patients treated with FPP after failure of the barbecue rotation, 4 were symptom free after FPP. Twenty five patients, including 5 non-responders with FPP, underwent no more rehabilitation maneuver. In most of cases (n=24), horizontal canal cupulolithiasis resolved spontaneously within a week. CONCLUSIONS: The direct effectiveness of physical therapy for horizontal canal cupulolithiasis is largely unsatisfactory. However, in many cases, horizontal canal cupulolithiasis resolved spontaneously in a few days.

The effect of fish consumption on blood mercury level in pregnant women / 대한산부인과학회지

OBJECTIVE: We studied relationship between average amount of fish consumption and blood mercury level in pregnant women, in addition we would like to know the blood mercury level in pregnant women in Korea and we compared the initial blood mercury level in pregnant women and followed up how much blood mercury level decreased after counseling and prenatal education. METHODS: Pregnant women who received prenatal care at the Yonsei medical center from March 2004 to September 2004, were targeted. They were divided into two groups. One was the study group who was educated to restrict the intake of fish, the other was the control group who was not given any prenatal education. We measured their blood mercury level and followed up until 2nd and 3rd trimester, to find out the differences between two groups. RESULTS: Out of the 63 pregnant women who participated in our study, we followed up 11 pregnant women in the study group and 13 pregnant women of control group. The initial mean blood mercury level of both groups was 2.94 (0.14-10.75) microgram/L. Blood mercury level in fish eating group of more than 4 times a month was higher than the others, which was statistically significant (p=0.02). Followed up blood mercury levels were increased in both groups, but there was not statistically significant between two groups. CONCLUSION: Pregnant women who consume a large amount of fish may have high blood mercury level. As fish intake seems to influence blood mercury level, to lower their blood mercury level, periconceptional education to decrease fish consumption might be necessary.

Differential diagnosis of pelvic masses with serum CA-125, ultrasound, and positron emission tomography / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether positron emission tomography (PET) is more valid than transvaginal ultrasonography (TVS) or serum CA125 in differentiating malignant ovarian tumor from benign ovarian tumor. METHODS: Fifty patients with adnexal tumor were evaluated with PET, TVS and serum CA 125 before surgery. PET was used to determine the uptake of FDG (18F-2-fluoro-2-deoxyglucose) for characterization of ovarian tumor. Sassone score was used as sonomorphological scoring system to distinguish from malignant to benign lesion. This scoring system is based on ovarian inner wall structure, wall thickness, septation, and echogenicity. Serum CA-125 levels were measured. After surgery, based on histopathologic findings, sensitivity, specificity, accuracy of each diagnostic modality at each cut-off value were calculated. And the validity of three diagnostic modalities was analysed further with receiver operating characteristics (ROC) curve. RESULTS: In the sonographic evaluation of adnexal tumors, the sensitivity and specificity were 63% and 76% at the cut off level of 9 of Sassone score. With PET, both sensitivity and specificity was not improved respectively. The ROC curves show that PET does not provide statistically significant benefits to predict ovarian malignancy. CONCLUSION: Our results suggested that CA-125 has no statistical significance and PET did not provide more significant additional diagnostic information than TVS for differentiation of malignant ovarian tumor from benign ovarian tumor.

Methylenetetrahydrofolate Reductase Gene Polymorphism in Korean Patients with Migraine or Ischemic Stroke

BACKGROUND: Methylenetetrahydrofolate reductase (MTHFR) gene polymorphism has been implicated in both migraine and ischemic stroke. The homozygous C677T mutation in the MTHFR gene was more frequent in the Japanese and Turkish migraineurs than in the control group. Positive associations have also been found in ischemic stroke. The purpose of this study is to investigate the role of MTHFR C677T polymorphism in Korean patients with migraine or ischemic stroke. METHODS: We analyzed the allele frequencies and genotype of MTHFR C677T polymorphism in 115 patients with migraine, 213 with cerebral infarction, and 73 controls. RESULTS: There was no significantly increased frequency of homozygosity for the T677 allele in both of the diagnostic groups, compared to the controls. CONCLUSIONS: Our results suggest that MTHFR gene C677T polymorphism is unlikely to play a major role in the pathogenesis of migraine or ischemic stroke in Korean patients.

Germline Mutations and polymorphisms of BRCA1 and BRCA2 in Sporadic Ovarian Carcinoma / 대한산부인과학회지

OBJECTIVE: Mutations in the BRCA1 and BRCA2 genes predispose women to ovarian and/or breast cancer. The purposes of this study were firstly to investigate the presence of BRCA1 and BRCA2 mutations in women with non-hereditary ovarian cancer and secondly to evaluate the relationship between ovarian cancer susceptibility gene polymorphism and clinicopathological features. METHODS: We studied 37 women who received a diagnosis of sporadic ovarian epithelial cancer and were treated at our hospital between August 2002 and March 2004. Genomic DNA was analyzed for BRCA mutations using PCR-DHPLC-sequencing method. And we examined the relationship between ovarian cancer susceptibility gene polymorphism and clinicopathological features using a high- throughput SNP scoring methods. RESULTS: Most mutations of BRCA1 and BRCA2 associated with ovarian and/or breast cancer resulted in truncated proteins. We found one frameshift mutation in BRCA1 (3746insA) led to premature termination. She has no family history of breast and ovarian cancer. There was no relationship between ovarian cancer susceptibility gene polymorphisms and clinicopathological features. CONCLUSION: Our results were consistent with the concept that there was a limited role of BRCA1 and BRCA2 mutations in ovarian carcinogenesis in Korean population and polymorphisms of some selected ovarian cancer susceptibility genes were not associated with the clinicopathological phenotypes of ovarian cancer.

Pure V1 Trigeminal Sensory Neuropathy due to Primary Pontine Hemorrhage

No abstract available.

Case Fatality After Ischemic Stroke and TIA in a Hospital-based Cohort: Long-term Effect of Complications

BACKGROUND: This study aimed to determine case fatality and short-term and long-term effects of complications in individuals who were admitted to a community-based hospital due to acute ischemic stroke or transient ischemic attack (TIA). METHODS: Between November 1998 and February 2001, all individuals with a suspected ischemic stroke or TIA, who admitted to Eulji General Hospital within 7 days from symptom onset, were registered prospectively and consecutively. Complications following stroke were defined as any comorbidities, including urinary tract infections, pneumonia, hemorrhages, ischemic heart disease, bed sore, fracture, etc. Case fatality was assessed by the national death certificate data from 1999 to 2001. RESULTS: Six-hundred thirty-one patients (mean age, 64.7 +/- 11.8 years; 309 males, 49%) with acute ischemic stroke or TIA were registered during 28 months. Duration of observation was 556.7 +/- 282.4 days. Thirty-day, 3-month, 1-year, and 2-year case fatalities were 5.1%. 10.1%, 18.3%, and 26.2% respectively. In subjects with complications, 30-day, 1-year, and 2-year case fatalities were 17.4%, 47.9%, and 58.4% respectively, while 0.7%, 7.6%, and 14.1% in subjects without complications (p<0.001). The presence of complications was a significant predictor of mortality following stroke (hazard ratio, 2.26) independent of age, sex, modified rankin disability score, NIH stroke scale at admission, TOAST classification, and risk factors of stroke. CONCLUSIONS: After acute ischemic stroke or TIA, 73.8% of patients survived more than 2 years. The occurrence of complications following stroke is an independent and strong predictor of short-term and long-term survival after acute ischemic stroke or TIA.

One Case of Placenta Accreta Treated with Selective Uterine Artery Embolization Followed by Methotrexate / 대한산부인과학회잡지

Placenta accreta is a rare but potentially lethal obstetric emergency due to massive hemorrhage, uterine perforation, and infection. Traditionally, hysterectomy was performed in the occurrence of serious hemorrhage. Currently, several conservative treatments including the use of uterine packing, leaving the placenta in situ, argon-beam coagulation, uterine artery ligation, administration of methotrexate, and uterine artery embolizations are introduced to preserve future reproductive potential. We present a patient with placenta accreta treated successfully with selective uterine artery embolization followed by methotrexate with brief review of literature.