Clinical Characteristics and Followup Assessment in Patients Diagnosed With Alzheimer’s Dementia Through Regional Dementia Centers and Conventional Hospital System

Background@#The rapidly increasing socioeconomic strain caused by dementia represents a significant public health concern. Regional dementia centers (RDCs) have been established nationwide, and they aim to provide timely screening and diagnosis of dementia. This study investigated the clinical characteristics and progression of patients diagnosed with Alzheimer’s dementia (AD), who underwent treatment in RDCs or conventional communitybased hospital systems. @*Methods@#This retrospective single-center cohort study included patients who were diagnosed with AD between January 2019 and March 2022. This study compared two groups of patients: the hospital group, consisting of patients who presented directly to the hospital, and the RDC group, those who were referred to the hospital from the RDCs in Pohang city. The clinical courses of the patients were monitored for a year after AD diagnosis. @*Results@#A total of 1,209 participants were assigned to the hospital (n = 579) or RDC group (n = 630). The RDC group had a mean age of 80.1 years ± 6.6 years, which was significantly higher than that of the hospital group (P < 0.001). The RDC group had a higher proportion of females (38.3% vs. 31.9%; P = 0.022), higher risk for alcohol consumption (12.4% vs. 3.3%; P < 0.001), and greater number of patients who discontinued treatment 1 year after diagnosis (48.3% vs. 39.0%; P = 0.001). In the linear regression model, the RDC group was independently associated with the clinical dementia rating sum of boxes increment (β = 22.360, R 2 = 0.048, and P < 0.001). @*Conclusion@#Patients in the RDC group were older, had more advanced stages of conditions, and exhibited a more rapid rate of cognitive decline than patients diagnosed through the conventional hospital system. Our results suggested that RDC contributed to the screening of AD in a local region, and further nationwide study with the RDC database of various areas of Korea is needed.

Hypothermia-induced acute kidney injury in an elderly patient

Hypothermia, defined as an unintentional decline in the core body temperature to below 35degrees C, is a life-threatening condition. Patients with malnutrition and diabetes mellitus as well as those of advanced age are at high risk for accidental hypothermia. Due to the high mortality rates of accidental hypothermia, proper management is critical for the wellbeing of patients. Accidental hypothermia was reported to be associated with acute kidney injury (AKI) in over 40% of cases. Although the pathogenesis remains to be elucidated, vasoconstriction and ischemia in the kidney were considered to be the main mechanisms involved. Cases of AKI associated with hypothermia have been reported worldwide, but there have been few reports of hypothermia-induced AKI in Korea. Here, we present a case of hypothermia-induced AKI that was treated successfully with rewarming and supportive care.

Intramural Gastric Abscess Caused by a Toothpick Presenting as a Subepithelial Tumor

In the present report, we describe an unusual case of an intramural gastric abscess caused by a foreign body, detected in the form of a subepithelial tumor. A 64-year-old woman was referred to our gastroenterology clinic for further evaluation of a gastric subepithelial tumor. The patient presented with a 1-month history of sustained dull epigastric pain. Esophagogastroduodenoscopy revealed an ill-demarcated, round, smooth, protruding lesion with a small central erosion on the great curvature of the proximal antrum. Endoscopic ultrasonography indicated the presence of an ovoid, heterogeneous, hypoechoic lesion with small echogenic foci located in the submucosa and muscularis propria layers. An abdominal computed tomography scan showed focal gastric wall thickening and regional lymph node enlargement. Endoscopic submucosal dissection was performed for definite diagnosis and management. Thus, we detected a toothpick and removed it using grasping forceps. The final diagnosis was an intramural gastric abscess caused by a toothpick.

Captured Macro-embolus of Fractured Atheromatous Plaque by the Embolic Protection Device during Carotid Stent Assisted Angioplasty / 신경중재치료의학

The authors present a case in which macro-embolus from the ruptured atheromatous plaque developed during carotid artery stenting (CAS). A 63-year-old man who had suffered a left middle cerebral artery territory infarction had significant proximal left internal carotid artery stenosis required CAS procedure. Immediate after stent deployment, the patient showed abrupt neurological deterioration with 12 x 3 mm sized macro-embolus which was caught by the embolus protection device (EPD). Retrieval of the macro-embolus was performed safely and the patient recovered to pre-procedure status. Macro-embolus can be resulted during the CAS. The EPD can capture the macro-embolus and safe removal is technically feasible.

A Case of Duodenal Obstruction Due to Intestinal Malrotation Diagnosed in Middle-aged Man

Intestinal malrotation occurs because of an arrest of normal rotation of the embryonic gut. It is often diagnosed in first month of life because of acute complications and requires surgical management. If it is not detected at a young age, it is diagnosed incidentally in advanced age. It is very rarely reported at advanced age with symptoms. In Korea in the last 30 years only about 10 such cases have been reported. In 2010, intestinal malrotation was reported at advanced age in only one case who had acute duodenal obstruction due to non-rotation of the pre-arterial segment of mid-gut. Therefore, we report a case of a 45-year-old man with non-rotation of pre-arterial segment with duodenal obstruction who had complained chronic and mild epigastric discomfort from a year ago.

A Case of Gastric Cavernous Hemangioma Diagnosed by Endoscopic Submucosal Dissection

Gastric cavernous hemangioma is a relatively rare benign gastric disease. Gastric hemangiomas are most commonly encountered in adulthood, although they can occur in any age group. While surgical resection is the curative treatment, endoscopic resection can be performed for treatment of selected cases. The patient was a 53-year-old male who was referred for evaluation of incidentally detected gastric subepithelial tumor with dense vascularity and oozing on the apex of the lesion. An EUS revealed a homogenously hypoechoic mass confined to the submucosal layer that showed no continuity with adjacent vessels, and there was no regional lymphadenopathy. Endoscopic submucosal dissection was successfully performed with en bloc resection. The final diagnosis was benign cavernous hemangioma of the stomach.

Catheter malposition rate following right subclavian venous catheterization

BACKGROUND: Malposition of a central venous catheter may cause several complications such as poor function of the catheter or cardiac tamponade. This study was designed to determine the incidence of malposition after subclavian venous catheterization at the university hospital. METHODS: We prospectively examined catheter locations from 367 subclavian vein catheterizations by an infraclavicular approach using postoperative chest X-rays to analyze the rate of catheter malposition. RESULTS: Primary misplacement was observed in 29 cases (7.9%). Seventeen cases were located in the right internal jugular vein, 8 cases (2.2%) were located in the left subclavian vein, 2 cases (0.5%) were located inside the right atrium, 1 catheter (0.3%) was kinking in the right subclavian vein and 1 catheter (0.3%) was located in the right brachiocephalic vein. CONCLUSIONS: Using the infraclavicular approach for subclavian catheterization, a central venous catheter was most commonly misplaced in the ipsilateral internal jugular vein. Operators must keep in mind that even experienced practitioners may cause a considerable number of malpositions and it is very important to check the chest X-ray to locate the catheter malposition after central venous catheterization.

Bilateral hydrothorax and cardiac tamponade after right subclavian vein catheterization: A case report / 대한마취과학회지

Central venous catheterization is typically used for the anesthetic management of patients undergoing a major surgery or care of patients in Intensive Care Unit (ICU). The occurrence of complications associated with central venous catheterization such as pneumothorax or vascular injury have decreased, while delayed complications such as hydrothorax, hydromediastinum, or cardiac tamponade have risen recently. We report a case of complications of bilateral hydrothorax with cardiac tamponade by superior vena cava perforation due to continuous mechanical force of the looped central venous catheter tip against SVC wall after subclavian vein cannulation.

Agenesis of Right Internal Carotid Artery Associated with Intracranial Aneurysm: Case Report

The authors present a case of unilateral agenesis of internal carotid artery associated with an aneurysm at the unusual site. A 22-years old female was admitted with sudden headache and nausea. She was alert on admission and no focal neurologic deficit was detected. Brain computed tomography(CT) scan showed subarachnoid hemorrhage. In the cerebral angiography, right internal carotid artery was absent and an aneurysm was arisen from the junction of the right middle cerebral artery and posterior communicating artery. The blood supply of the right anterior cerebral artery was maintained from the left internal carotid artery via the anterior commuicating artery. The territory of the right middle cerebral artery was supplied from the basilar artery through enlarged right posterior communicating artery. Direct clipping of the aneurismal neck was performed through right pterional approach. In the postoperative high resolution CT scan, there was no carotid canal in the right skull base suggesting agenesis of the right internal carotid artery.

Fenestrate Anomaly of a Vertebral Artery with Repeated Attacks of Ischemic Stroke

In angiographic examinations, abnormalities of vertebral arteries are incidental findings because they are, in most of cases, clinically asymptomatic. We report a case of young woman with a fenestrated anomaly of the left vertebral artery with ischemic strokes. The patient was suffered from repeated attacks of transient ishemic attack(TIA) and cerebral infarction. Vertebral angiography demonstrated a fenestrated anomaly of the left vertebral artery and a large intraluminal thrombus was detected at just proximal of the fenestration. Proximal balloon occlusion of the involved vertebral artery was done and the patient became free from ischemic attack. Follow-up angiography showed well visualization of the posterior circulation through right vertebral artery and the ballooned vertebral artery was well occluded. The left posterior inferior cerebellar artery(PICA) was filled well via collateral circulation from the opposite side.

Nontraumatic Spinal Epidural Hematoma - An Analysis of The Etiology -

Spontaneous spinal epidural hematoma is a rare entity. Various definitions for spontaneous epidural hematoma have been reported in the literature. The expression of nontraumatic spinal epidural hematoma seems to be less ambiguous and includes idiopathic hematomas and hematomas secondary to coagulopathy, vascular malformations, and tumors. We report three cases of nontraumatic spinal epidural hematomas observed from 1991 to 2000. The causes of the spinal epidural hematomas were not clear in two cases among them, but in the another one case, the cause was determined to be an acquired coagulopathy. We reviewed 24 cases reported in the Korean Journal of Neurosurgery and our three cases with particular emphasis on the various causes such as coagulopathy, vascular malformations and tumors. Among the 27 cases, numerous causes were detected such as three cases of vascular malformation, one case of anticoagulant treatment, five cases of combined lumbar disc herniation, two cases associated with pregnancy and postpartum, one case associated with hypertension, and one case associated with ossification of ligamentum flavum. No causes were detected in the ten cases. The authors reviewed the literature.

Comparative study of the Effectiviness Among the four Types of Induced Hypotensive Anesthetic Methods in Maxillofacial Reconstructive Surgery

In the maxillofacial surgery, close care is mandatory during operation and anesthesia. The surgical field is limited since most procedure is done through the mouth. In this situation, airway management and blood pressure controls are keystone. So, the induced hypotensive anesthesia is essential to the maxillofacial surgery for bleeding control and accurate operation. One hundred and ninety-eight cases of maxillofacial surgery was carried out under induced hypotensive anesthesia from 1991 to 1999. Authors divided them into 4 groups based on the anesthetic protocol. In group 1(n = 43) inhalation anesthetics(enflurane, halothane) and sodium nitroprussde(SNP) were used; in group 2(n = 99) inhalation anesthetics(enflurane), SNP and labetalol were used; In group 3(n = 27) inhalation anesthetics(enflurane) and labetalol were used; In group 4(n = 29) total intravenous anesthesia(propofol, fentanyl, midazolam) was applied with SNP, and esmolol(or labetalol). The patient records were retrospectively studied during the operation and anesthesia, including degree of fluctuation in the mean arterial blood pressure, amounts of the blood loss and transfusion during the operation, complications, and the period of hospitalization. Mean operation time of 4 groups decreased in order. The blood pressure was controllable without reflex tachycardia in beta-blocker using groups. Amount and incidence of transfusion was smaller in total intravenous anesthesia group. However there were no significant differences in total admission days and ICU stay periods between 4 groups.

Solitary Schwannoma in the Psoas Muscle

The vast majority of schwannomas occur on cranial nerves, and rarely in the retroperitoneum. Solitary schwannoma in the psoas muscle is extremely rare. The authors present a case of retroperitoneal neoplasm in the psoas muscle identified as schwannoma which is not associated with von Recklinghausen's disease. A 68 years old female patient was admitted because of low back pain and weakness at the left leg. CT and MRI revealed a large cystic mass with well-defined margin and multiple internal septation within the left psoas muscle. The tumor was totally extirpated and histologically confirmed as a schwannoma.

A Perioperative Thromboelastographic Coagulation Study of Patients Treated with a Massive Transfusion of Fluids and Packed Red Cells during Total Hip Replacement Surgery / 대한마취과학회지

BACKGROUND: The high incidence of deep vein thrombosis (DVT) of lower extremities and a subsequent pulmonary embolism (PE) makes it the most common cause of death following total hip replacement surgery. Therefore, the authors measured the perioperative changes in the blood coagulation activity with a thromboelastography (TEG) in the patients treated with fluid and packed red cells (PRC). METHODS: Hemodilution was estimated with a measurement of hemoglobin (Hb), hematocrit (Hct), and platelet count. The changes in the coagulation factor activities were measured with TEG. Samples were obtained before skin incision (step 1); at the period that Hb and Hct ranged from about 10 g/dl to 30% (step 2); in the postanesthetic care unit (step 3); and on the postoperative first and third day (step 4, 5). RESULTS: Although Hct and Hb decreased to 9.4% statistically at step 2 only, platelet counts were significantly decreased in step 2 (10.6%), 3 (34.5%), 4 (32.5%), and 5 (33.6%) compared with step 1 (P < 0.05). At step 2, there were no significant changes in TEG parameters except r time, which decreased (21.5%) (P < 0.05). At step 3, r time, alpha angle, and maximum amplitude (MA) decreased, and k time and lysis 60 increased (P < 0.05). CONCLUSIONS: In spite of consumption and dilution of coagulation factors after massive fluids and PRC therapy during total hip replacement surgery, the increased activities of procoagulants and decreased fibrinolytic activities predisposed the body to initiate and maintain the thrombus.

In Vitro Coagulation Study of Hemodiluted Blood with Hydroxyethyl Starch by Thromboelastography / 대한마취과학회지

BACKGROUND: To avoid the risks associated with transfusion of homologous blood products, artificial colloid solutions represent an alternative for intra-operative blood loss replacement. However, synthetic colloids have been implicated as a cause of coagulopathy when administered in large quantities. We investigated the effect of Hydroxyethyl starch (HES) on blood coagulation in vitro under thromboelastography (TEG). METHODS: Whole blood was withdrawn from fifteen volunteers undergoing peripheral surgery who had no history of coagulation defect. Whole blood was diluted with HES to 25, 50 and 75 vol% concentrations, and the changes in coagulation status were analysed using TEG and were compared with those of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilution with HES solution at 50 vol% concentration decreased the MA and alpha angle values (P < 0.05), but the R and K values remained unchanged. In case of profound hemodilution at a 75 vol% concentration, the values of MA and alpha angle were severely decreased (P < 0.05) and the values of R and K were severely increased (P < 0.05). CONCLUSIONS:There were many reports that moderate hemodilution with crystalloids increased coagulability, but hemodilutions up to 50 vol% concentration with HES solution did not significantly change blood coagulability. Significant hypocoagulability occurred at a 75 vol% hemodilution with HES.

Clinical Roles of Continuous Lumbar Drainage in Acute Hydrocephalus Patients

No abstract available.

Primary Osteosarcoma of the Sphenoid Bone: Case Report

No abstract available.

Carcinogenesis of Murine Astrocytes in Culture

Astrocytes play important roles in normal brain development and the physiological processes. In particular, 30% of the brain volume consists of astrocytes, and they are the primary target cell in the brain for cellular injuries from chemical exposures. The present study attempts to establish an immortalized murine astrocyte cell line to study the mechanisms of chemical-induced carcinogenesis of astrocytes. Primary astrocytes isolated from mice were transfected with plasmid carrying the SV40 T antigen. Clonal cells obtained after G418 selection were continuously subcultured to establish an immortalized astrocyte cell line. The cell line was positive on GFAP expression and was sensitive to exposure to such chemicals as MNNG. Cells were treated with MNNG for 5 days, with doses ranging from 0.001ug/ml to 1ug/ml. Dose-dependent cellular transformations of astrocytes were observed. Treatments at 0.01ug/ml showed the most distinct characteristics of neoplastic transformation. Subsequent treatment with TPA produced higher levels of neoplastic cell transformation than MNNG treatment alone, as evidenced by increases of saturation density, soft-agar colony formation and cell aggregation. Promotional effects of TPA on cell transformation was further demonstrated by the shortening duration of foci appearance. Addition of hydrocortisone to the culture media resulted in further promotion of cell transformation in astrocytes treated with MNNG and TPA, suggesting that glucocortocoid also plays a role in the promotion of chemical-induced astrocyte transformation. The present study demonstrates that astrocytes are susceptible to chemical-induced carcinogenicity and subject to mechanisms of multistage carcinogenesis. Analysis of MNNG-transformed astrocytes showed that, while the expression of TGF-beta was decreased, expression of GFAP, IL-1betaand fibronectin were increased. The results suggest that these factors are associated with mechanisms of MNNG-induced astrocyte transformation and may be used as potential candidates for biomarkers representing astrocyte-related tumors and cell toxicities. The study showed scientific evidence that growth factors, cytokine and the extracellular matrix are involved in processes of chemical-induced transformation of astrocytes. In addition, the present work provided an excellent opportunity to develop an immortalized astrocyte cell line that can be used for studying mechanisms of astrocyte-related diseases.

A Huge Posterior Fossa Arachnoid Cyst with Cervicothoracic Syringomyelia

The authors report a surgically treated patient with very unusual combination of a giant posterior fossa cyst in cerebellopontine area, Chiari I malformation and syringomyelia in cervico-thoracic area. Ventricles were not dilated. He complained weakness and clumsiness on the right upper extremity. His symptom was attributable to the syringomyelia of cervical spinal cord. The authors managed this patient by removing the arachnoid cyst and cystoperitoneal shunt on the assumption that this cyst has an influence on the formation of Chiari malformation and syringomyelia. After operation there was marked improvement in the motor power in the arm, and a follow-up MRI one month later showed a disappearance of syringomyelia. The authors believe that this very unusual condition is of interest in making the pathogenesis of syringomyelia clear.

In Vitro Aprotinin Enhanced Anticoagulation Synergistically to Heparinized Blood on Thromboelastography / 대한마취과학회지

BACKGROUND: Aprotinin is a potent, nonspecific broad serine protease inhibitor. It's inhibitory effects on intrinsic pathway of coagulation cascade can augment anticoagulation by heparin. This study designed to demonstrate augmented anticoagulation of aprotinin to heparin contaminated blood on thromboelastography(TEG). METHODS: This study designed into two phases for 21 healthy volunteers undergoing elective opeation. The first phase study, it was for looking at TEG differences between blood treated with aprotinin 200 KIU and blood treated with heparin 0.05 unit and 0.1 unit per blood 1 ml. The second phase study was for looking at anticoagulation of aprotinin added by heparin 0.05 unit and 0.1 unit per blood 1 ml and their reversal added by optimal dose of protamine sulfate. RESULTS: The aprotinin treated blood showed only a prolonged reaction time. Blood treated with incremental dose of heparin showed longer reaction time and smaller alpha angle than TEGs of native blood. Aprotinin added to the heparin contaminated blood showed much longer reaction time and much less alpha angle when compared with TEGs of aprotinin or heparin treated blood. Depressed TEG pattern by the heparin and aprotinin mixture reversed back to the TEGs of blood treated with aprotinin when optimal dose of protamine added. CONCLUSIONS: Those results suggest that aprotinin administered in open cardiac surgery can augment the remained anticoagulation effect due to heparin even after first dose fo protamine after weaning of cardiopulmonary bypass. This is of clinically improtance to distinguish heparin related coagulopathy from heparin non related coagulopathy by thromboelastography.