Subclassification and clinical treatment options of refractory atlantoaxial dislocation / 中华骨科杂志

Objective:To subdivide clinical classification of refractory atlantoaxial dislocation, and evaluate the reliability of new subdivide clinical classification of refractory atlantoaxial dislocation.Methods:From January 2010 to December 2018, 48 patients with refractory atlantoaxial dislocation were treated, including 19 males and 29 females, aged 16 to 65 years, with an average of 39.2±13.3 years. According to the changes of relative anatomical position of C 1 and C 2 under general anesthesia with heavy traction of 1/6 body weight, subdivide clinical classification of refractory atlantoaxial dislocation were proposed, and refractory atlantoaxial dislocation was divided into traction loosening type (atlantoaxial angle≥5°) and traction stabilization type (atlantoaxial angle<5°). The traction loosening type was directly reduced by posterior atlantoaxial screw-rod fixation and fusion without anterior or posterior soft tissue release. For traction stabilization type, transoral soft tissue release was performed first, and then transoral anterior reduction plate fixation and fusion or posterior atlantoaxial screw-rod fixation and fusion were performed. Atlantodental interval (ADI) and atlantoaxial angle (AAA) were measured and collected before and after surgery to evaluate atlantoaxial reduction. The space available for the spinal cord (SAC) were measured to evaluate spinal cord compression. Visual analogue score (VAS) was used to evaluate the neck pain levels, and Japanese Orthopaedic Association (JOA) scores was used to evaluate the neurological function. American Spinal Cord Injury Association impairment scale (AIS) was used to evaluate the degree of spinal cord injury. One week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT scan were checked, in order to evaluate the reduction, internal fixation and bone graft fusion. Results:Among all 48 cases, 22 cases were traction loosening type, of which posterior atlantoaxial screw-rod fixation and fusion were performed in 16 cases and occipitocervical fixation and fusion in 6 cases. 26 cases were traction stabilization type, and they all underwent anterior transoral release, and then, anterior TARP fixation and fusion were performed in 24 cases and posterior screw-rod fixation and fusion in the other 2 cases. X-ray, CT and MRI images and of all patients 1 week after surgery showed good atlantoaxial reduction and decompression of spinal cord. In each of the two types, there was one case lost to follow-up. For 46 cases in follow-up, the follow-up time ranged from 6 to 72 months, with an average of 38.0±17.2 months. Among 46 cases, 21 cases of traction loosening type showed that, ADI reduced from preoperative 9.9±2.2 mm to 2.3±0.9 mm at 3 months after surgery and 2.3±1.0 mm at the last follow-up, AAA increased from preoperative 57.9°±12.3° to 91.0°±2.2° at 3 months after surgery and 90.9°±2.2° at the last follow-up, SAC increased from preoperative 9.8±1.3 mm to 15.1±0.7 mm at 3 months after surgery and 14.9±0.7 mm at the last follow-up, VAS score reduced from preoperative 1.5±2.1 to 0.7±1.0 at 3 months after surgery and 0.3±0.6 at the last follow-up, and JOA score increased from preoperative 10.2±1.7 to 13.3±1.3 at 3 months after surgery and 14.9±1.5 at the last follow-up. Twenty-five cases of traction stabilization type presented that, ADI reduced from preoperative 9.7±2.0 mm to 2.1±1.4 mm at 3 months after surgery and 2.1±1.3 mm at the last follow-up, AAA increased from preoperative 55.8°±9.2° to 90.9°±1.4° at 3 months after surgery and 90.9°±1.3° at the last follow-up, SAC increased from preoperative 10.5±1.0 mm to 15.4±0.5 mm at 3 months after surgery and 14.8±2.8 mm at the last follow-up, VAS score reduced from preoperative 1.7±2.1 to 0.7±0.9 at 3 months after surgery and 0.3±0.5 at the last follow-up, and JOA score increased from preoperative 10.1±1.3 to 12.9±1.5 at 3 months after surgery and 14.4±1.3 at the last follow-up. In the traction loosening type, all the 10 grade D patients were improved to grade E at the last follow-up. In the 2 grade C patients of traction stabilization type before surgery, 1 patient was improved to grade E, 1 patient was improved to grade D, and all 11 patients with grade D were improved to grade E at the last follow-up. Bony fusion was obtained in all patients from 3 to 6 months, with an average of 4.4±1.5 months. During follow-up period, no looseness of internal fixation or redislocation happened.Conclusion:Refractory atlantoaxial dislocation can be divided into traction loosening type and traction stabilization type. For traction loosening type, satisfactory reduction can be achieved by using posterior atlantoaxial screw-rod system without soft tissue release. For traction stabilization type, anterior release is preferable, and then anterior TARP or posterior screw-rod can be used to achieve satisfactory reduction.

Advances in morphological and functional studies on the paraventricular thalamic nucleus / 解剖学报

Paraventricular thalamic nucleus (PVT) is an essential component of the midline thalamus, which has been regarded as a transmit relay nucleus and an integrated center in multiple behaviors including wakefulness, food intake, addiction, reward and fear memory. PVT is predominantly populated with glutaminergic excitatory neurons expressing vesicular glutamate transporter-2 (VGluT2) but without GABAergic inhibitory neurons. Therefore, based on the paradox of its multiplexed roles in different behaviors and its comparatively simplex excitatory nature, more specific subclassification of excitatory PVT neurons is required in studies in this field. In the present review, morphological and electrophysiological characteristics, efferent and afferent connections, and morphological and functional distinctions in anterior subregion and posterior subregion of PVT are summarized. In addition, neural connections and neurochemical properties are used as subclassification criteria in PVT neurons. This review might explain the integrated role of PVT in different behaviors, which would be helpful for further studies on the PVT.

Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the ‘beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification. MATERIALS AND METHODS: One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). CONCLUSION: In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.

DNA methylation-based subclassification of psoriasis in the Chinese Han population / 医学前沿

Psoriasis (Ps) is an inflammatory skin disease caused by genetic and environmental factors. Previous studies on DNA methylation (DNAm) found genetic markers that are closely associated with Ps, and evidence has shown that DNAm mediates genetic risk in Ps. In this study, Consensus Clustering was used to analyze DNAm data, and 114 Ps patients were divided into three subclassifications. Investigation of the clinical characteristics and copy number variations (CNVs) of DEFB4, IL22, and LCE3C in the three subclassifications revealed no significant differences in gender ratio and in Ps area and severity index (PASI) score. The proportion of late-onset ( ≥ 40 years) Ps patients was significantly higher in type I than in types II and III (P = 0.035). Type III contained the smallest proportion of smokers and the largest proportion of non-smoking Ps patients (P = 0.086). The CNVs of DEFB4 and LCE3C showed no significant differences but the CNV of IL22 significantly differed among the three subclassifications (P = 0.044). This study is the first to profile Ps subclassifications based on DNAm data in the Chinese Han population. These results are useful in the treatment and management of Ps from the molecular and genetic perspectives.

Subclassification of Hepatocellular Carcinoma with Barcelona Clinic Liver Cancer Intermediate Stage

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer (BCLC) intermediate stage includes a highly heterogeneous population. Here, we aimed to sub-classify hepatocellular carcinoma with BCLC intermediate stage for better prognostification. METHODS: Between 2003 and 2008, 325 patients who were newly diagnosed as HCC with BCLC intermediate stage were considered eligible. Tumor factor and liver function were used for sub-classification. Overall survival (OS) was analyzed using Kaplan-Meier method with a comparison by log-rank test. RESULTS: A total of 325 patients with intermediate stage HCC were analyzed. Patients with tumor size ≥7 cm, tumor number ≥4 and Child-Pugh class B had the worse OS compared to those with tumor size <7 cm, tumor number <4 and Child-pugh class A, respectively (all P<0.05). These three variables affected the OS independently from multivariate Cox regression analysis (all P<0.05). So, using these three variables, patients were finally sub-classified as those with fulfilling none of three factors (B-a), one of three factors (B-b), two of three factors (B-c) and all of three factors (B-d) with the median OS of 39.2, 20.6, 12.0 and 8.3 months with statistical significances (all P<0.05 between B-a and B-b, between B-b and B-c, and between B-c and B-d), respectively. CONCLUSIONS: Sub-classification of HCC with BCLC intermediate stage may be useful in not only prognostification but also guidance of treatment strategies.

Evaluation of the Outcome after Transarterial Chemoembolization; Refinement of Barcelona Clinic Liver Cancer Stage-B from Eastern Point of View

Transarterial chemoembolization (TACE) is recommended as the first line treatment option for the patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), however, treatment strategy and evaluation of effects after TACE has not been fully established. Recently, sub-stage of BCLC stage B has been proposed and validated, but it should be validated including a large number of the patients and its refinement should be discussed. We have validated the sub-stage of BCLC stage B (B1-B4) by comparing overall survival after TACE, and there was no statistically significant difference in overall survival after TACE between B1 and B2. After excluding the patients with Child-Pugh point 7 from B1, the overall survival was significantly better than that of B2. Therefore, up-to-seven criteria is shown to be a reliable tool for the treatment strategy in the patients with intermediate stage of HCC. Refinement of sub-stage of BCLC stage B has been proposed by some other institutes, and it is important to establish novel treatment strategy for the patients with BCLC stage B after TACE to improve the prognosis of the patients after TACE, and to define the best timing for conversion to sorafenib or liver transplantation should be discussed.

Relationship of Bilirubin with Acute Ischemic Stroke and Chinese Ischemic Stroke Subclassification / 中国康复理论与实践

Objective To investigate the relationship of the serum bilirubin level with acute ischemic stroke (AIS), and Chinese isch-emic stroke subclassification (CISS), stroke severity and short-term outcome of AIS patients. Methods 616 patients with AIS as well as 664 patients without stroke matched with gender and age were compared and analyzed with the non-conditional Logistic regression. The AIS pa-tients were divided based on the CISS, and their bilirubin levels were compared. The AIS patients were divided into high bilirubin group and normal bilirubin group, their scores of the National Institute of Health Stroke Scale (NIHSS) as admission and discharge, and neural func-tion improvement rate were compared. Results The levels of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) were higher in the AIS group than in the control group (P0.05). The NIHSS score was higher in the high bilirubin group than in the normal bilirubin group as admission (P0.05), nor the rate of neural function improvement (P>0.05). Conclusion The serum bilirubin level elevated and correlated with the severity in the AIS patients, which might be the risk of pathogenesis and AIS. The bilirubin was not various with the CISS, and might be less involved in the short-term outcome of AIS.

Comparative analysis of general characteristics of ischemic stroke of BAD and non-BAD CISS subtypes / 华中科技大学学报（医学）（英德文版）

Based on the recently proposed Chinese ischemic stroke subclassification (CISS) system, intracranial branch atheromatous disease (BAD) is divided into large artery atherosclerosis (LAA) and penetrating artery disease (PAD). In the current retrospective analysis, we compared the general characteristics of BAD-LAA with BAD-PAD, BAD-LAA with non-BAD-LAA and BAD-PAD with non-BAD-PAD. The study included a total of 80 cases, including 45 cases of BAD and 35 cases of non-BAD. Subjects were classified using CISS system: BAD-LAA, BAD-PAD, non-BAD-LAA and non-BAD-PAD. In addition to analysis of general characteristics, the correlation between the factors and the two subtypes of BAD was evaluated. The number of cases included in the analysis was: 32 cases of BAD-LAA, 13 cases of BAD-PAD, 21 cases of non-BAD-LAA, and 14 cases of non-BAD-PAD. Diabetes mellitus affected more non-BAD-LAA patients than BAD-LAA patients (P=0.035). In comparison with non-BAD-PAD, patients with BAD-PAD were younger (P=0.040), had higher initial NIHSS score (P<0.001) and morbidity of ischemic heart disease (P=0.033). Within patients with BAD, the PAD subtype was associated with smoking (OR=0.043; P=0.011), higher low-density lipoprotein (OR=5.339; P=0.029), ischemic heart disease (OR=9.383; P=0.047) and diabetes mellitus (OR=12.59; P=0.020). It was concluded that large artery atherosclerosis was the primary mechanism of BAD. The general characteristics showed no significant differences between the CISS subtypes of LAA and PAD within BAD, as well as between the BAD and non-BAD within LAA subtype. Several differences between PAD subtypes of BAD and non-BAD were revealed.

Relationship between high sensitive C-reactive protein and stroke subtype according to Chinese Ischemic Stroke Subclassification criteria in patients with acute cerebral infarction / 中华全科医师杂志

By analyzing the clinical data of 216 cases of acute cerebral infarction (ACI) from 2012 January to 2013 June retrospectively,we found that the serum levels of high sensitive C-reactive protein (hs-CRP) in patients were significantly higher than those in 186 controls (P ＜0.01).The degree of neural function defect in ACI patients was assessed by the National Institutes of Health Stroke Scale (NIHSS) score.The hs-CRP level of the patients with NIHSS score ＞ 8 were higher than that in those with NIHSS score ≤8 (P ＜ 0.05).The hs-CRP level of patients of large artery atherosclerosis were (6.32 ± 4.12) mg/L and the positive rate of hs-CRP was 85.7％ (84/98).All were respectively higher than those in patients of penetrating artery disease [(1.97 ±0.86) mg/L,7/71],cardiogenic stroke [(3.70 ± 2.76) mg/L,14/24],undetermined etiology [(3.43 ± 3.52) mg/L,5/11] and other etiologies [(3.41 ± 3.25) mg/L,5/12] (all P ＜ 0.05).Logistic regression analysis was performed for the risk factors of ACI.The correlative factors of ACI included hypertension,diabetes mellitus,atrial fibrillation,smoking,total cholesterol,homocysteine and high sensitive C-reactive protein (OR =1.56,1.19,1.23,1.17,3.08,1.34,1.25,all P ＜ 0.01).The serum levels of hs-CRP increased significantly in ACI patients and were correlated with the degree of neural function defect.

Study of intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA)in isolatedpenetrating artery territory infarcts / 中华急诊医学杂志

Objective To investigate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rtPA)in patients with isolated penetrating artery territory infarct (IPAI).Methods Data of retrospectively collected clinical,laboratory,and radiological from 75 consecutive patients with acute ischemic stroke treated with intravenous rtPA therapy from June 2009 to April 2011.Etiological classification was carried out according to the Chinese Ischemic Stroke Classification of Subgroups(CISS).The rates of hemorrhagic transformation(HT)and clinical outcomes of patients were compared between IPAI group and non-IPAI group.Results All 75 patients with mean age of 67.4years and 25(33.3％)fenale,were treated with intravenous rtPA.Before treatment,their average score of the National Institutes of Health Stroke Scale(NIHSS)was 12.3 ± 6.4,and mean length of time from onset to treatment was 239.6 ±97.5 minutes.After thrombolytic therapy,the radiological HT was found in 24 patients(32％).Symptomatic intracraneal hemorrhage(ICH)occurred in 4 patients(5.3％).Of 22 (29.3％)patients with IPAI,only one experienced HT.Logistic regression analysis suggested that IPAI wasan individualized predictor used alone for determining the low risk of HT.In the patients with IPAI,82％ of them had an individual clinical outcome(mRS ＜ 2)one month after onset,and the neurological outcomes were better in patients with IPAI than those in patients with non-IPAI(P ＜ 0.01).Conclusions The risk of hemorrhagic complication was low and the clinical outcome was good in patients with isolated penetrating artery territory infarct after intravenous thrombolytic therapy with rtPA.Imaging diagnosis of IPAI might facilitate the treatment with rtPA in this cohort of patients.

Subclassification of Stage IV Gastric Cancer According to the Presence of Distant Metastasis (IVa and IVb)

PURPOSE: The TNM staging system showed limitation in stratifying patients into different prognostic groups with gastric cancer. Since the treatment for stage IV gastric cancer with distant metastasis (M1) is defined as non-curative one, we hypothesized that the survival rate of stage IV gastric cancer with M1 is different to that of stage IV gastric cancer with no distant metastasis (M0), which will provide a rationale to subdivide stage IV into IVa and IVb. MATERIALS AND METHODS: From June 1992 to December 2005, of 1,630 gastric cancer patients who underwent surgery, 308 patients with stage IV gastric cancer were selected and analyzed. The clinicopathologic characteristics and survival of the patients, according to distant metastasis, were determined retrospectively. Median follow-up period was 13 months (range: 1~154 month). RESULTS: 5 year survival rate of M0 and M1 group was 35% and 16% respectively with statistic significance (P=0.0000). When the survival rate of M0 group was analyzed according to the difference of T and M factor, T1-3N3M0 and T4N1-2M0 group showed no significant statistical difference (P=0.1898). CONCLUSION: Given the result in this study, we suggest that the stage IV gastric cancer be subclassified into stage IVa and IVb according to M factor.

Electrophysiological Classification of Guillain-Barre Syndrome: Sequential Changes in Electrophysiologic Findings

BACKGROUND: Guillain-Barre syndrome (GBS) is subclassified into acute inflammatory demyelinating polyneuropathy, acute motor or motor-sensory axonal neuropathy, and the other variants. While most studies from Western countries report demyelinating type as predominant form of GBS, some reports from Asian countries suggest the opposite result. Because they are not easily discriminated clinically, electrophysiological study is the most practical method for their subclassification. METHODS: Among the patients who had been admitted to our hospital with typical clinical features of GBS over the past 4 years, we analyzed 32 patients, who had undergone at least 2 serial nerve conduction studies (NCS) throughout the course. In each case, conventional NCS in at least 3 limbs were performed and the criteria of Hadden et al., and 2 other criteria were applied. RESULTS: Using the criteria of Hadden et al., 91% of the patients were classified as primary demyelination, and none as primary axonal pathology. Among the cases of primary demyelination, 21% showed electrophysiological features of axonal GBS at least in one occasion during the serial studies. CONCLUSIONS: Our study suggests that the primary demyelinating type is by far more predominant in our population. Secondary changes of electrophysiological findings in some of our cases suggest that primary demyelination could be misinterpreted as primary axonal pathology without timely serial studies. For the epidemiologic study of larger scale in conjunction with clinical features and immunologic investigations, the protocol and criteria of consensus is necessary, with the qualified normal limit values of each laboratory.

Significance of Subclassification of Depressed-Type Early Colorectal Cancer Based on Growth and Development

PURPOSE:Recently it became obvious that some early cancers which appeared to be polyp lesions had actually originated from depressed-type lesions. The aim of this study was to clarify both the characteristics of depressed- type early colorectal cancers compared with protruded- or flat-type ones and the significance of a subclassification of depressed-type early cancers. METHODS:The authors experienced 248 early colorectal cancers from 1996 to 2000. We classified those cancers into protruded, flat, and depressed types based on growth and development. Further, we used Kudo's classification to subclassify the depressed-type cancers into three sub-types, IIc, IIa+IIc, and Is+IIc. We analyzed the 248 cases with emphasis on size, type, sub-type, and submucosal cancer (sm) rate. RESULTS:The sm rate of the depressed cancers was 81.8% (18/22) and was significantly higher than those of the protruded (30.5%) or the flat (38.5%) types (P<0.05). The sm rate of the depressed lesions not larger than 10 mm was 70% (7/10) and that of the lesions from 11 mm to 20 mm was 91.7% (11/12); there were no depressed cancers larger than 20 mm in diameter. The sm rate of the type IIa+IIc plus type Is+IIc lesions was higher than that of type IIc lesions (93.3%, 14/15 vs. 57.1%, 4/7). Endoscopic resection was done in 74.2% of all early colorectal cancers. CONCLUSIONS:The sm rate of depressed-type early colorectal cancers was 82%, and no depressed cancers were larger than 20 mm in diameter, suggesting that by the time a depressed-type cancers had become larger than 20 mm in size, it had already progressed into an advanced cancer. Thus, it is very important to detect depressed-type cancers in an early stage. Moreover, it is imperative to differentiate type IIa+IIc and type Is+IIc from polyp lesions and to manage them cautiously because their sm rate is higher than that for type IIc lesions.

Clinicopathological Analysis and Subclassification of Submucosal Gastric Adenocarcinoma

BACKGROUND: The aim of this study was to determine the independent prognostic factors in submucosal gastric adenocarcinomas, especially after subclassifying them according to their degree of invasion into the submucosal layer of the stomach. METHODS: Among the gastric cancer patients who were diagnosed and operated on at the Department of General Surgery, Hanyang University Hospital, during the ten years from 1987 to 1996, 169 cases of submucosal tumors were analyzed. One hundred and twenty-eight cases of mucosal tumors and 132 cases of proper muscle tumors were compared with a control group of submucosal tumors. All the pathologic slides of the submucosal tumor cases were reviewed again and were subclassified into sm1, sm2, and sm3 according to their depth of invasion. Several clinico-pathological factors, including age, sex, lymph node metastasis, histologic differentiation, macroscopic type, depth of invasion, and size of tumor, were evaluated and analyzed. RESULTS: The ratio of lymph node metastasis increased with the degree of submucosal invasion; however, there was no relation with the size of the tumor. Among various factors, the subclassification of the depth of submucosal invasion was the only factor influencing the ratio of lymph node metastasis; however, these subclassifications did not independently influence the survival rates. The survival rate of patients with larger submucosal tumors was better than that of patients with smaller ones. The univariate and the multivariate survival analyses applied to these factors showed that age, lymph node metastasis, and size of tumor were meaningful prognostic factors. CONCLUSIONS: For the application of endoscopic mucosal resection for sm1 tumors, we should develop more delicate preoperative diagnostic methods which can accurately subclassify the submucosal tumor into sm1, sm2, or sm3.

Clinical Charateristics of Chronic Daily Headache Patients Visit to University Hospital

BACKGROUND: Chronic daily headache(CDH) could be included all of the primary headache disorders with daily or near-daily headache lasting more than 4 hours/day for 15 days/month. Several studies have shown that patients with CDH are difficult to classify using the currently published International Headache Society(HIS) system. Recently, some authors recommended that CDH could be subclassified into transformed migraine(TM), chronic tension-type headache(CTTH), new daily persistent headache(NDPH) and hemicrania continua(HC). METHODS: We analysed 100 patients with CDH who were diagnosed in Taegu-Hyosung Catholic University Hospital from February 1996 to May 1998. To describe clinical features of CDH, we used our CDH protocol. RESULTS: (1) Most of the patients were in their 5th-7th decades, and female was predominantly affected(female to male ratio, 7.3:1). (2) The subclassification of CDH were CTTH in 59 patients, TM in 33 patients, NDPH in 7 patients, and HC in 1 patient. (3) Clinical characteristics of CDH were mostly bilateral location, mild to moderate intensity and dull nature. The mean onset age of CDH was 47.7 years, the onset time of the day was in the afternoon or anytime, the duration was more than 4 hours or 12 hours in 90 patients, and the frequency was near-daily or daily in 80 patients. Common associated symptoms were nausea, dizziness, insomnia, fatigue, photophobia, blurred vision, and scalp tenderness. (4) Daily use of analgesics was reported in 66 patients. CDH was aggravated during premenstrual period in 10 patients. Positive family history was shown in 26 patients. CONCLUSIONS: We present this report because knowledge of clinical characteristics and adequate protocol for CDH in clinical practice is necessary.

Clinicopathological Analysis of Stage IV Gastric Cancer

BACKGROUND: Gastric cancer continues to present a therapeutic challenge because it is one of the most common carcinomas in the world. This study attempted to identify the prognostic effect of gastric resection and to clarify the meaning of distant metastasis in stage IV gastric cancer patients. METHOD: It was a retrospective study using 174 stage IV gastric cancer patient (96 who was operated on and 78 who was not) who were diagnosed during the four years from 1992 to 1996. Several clinicopathologic factors were analyzed to find their prognostic significance for these patient. RESULT: The mean survival duration (MSD) was significantly different according to whether or not an operation was performed, being 18.8 0.6 months for the group that was operated on and 5.4 0.6 months for the group that was not operated on (p=0.0000). With respect to the stage IV patients who was operated on, the MSD was significantly different depending on the Borrman's classification (types 2/3/4 with 11.3 +/- 2.7, 23.0 +/- 2.7, and 8.3 +/- 1.8 months, respectively, p=0.008) as was the presence of distant metastasis (MO/M1 with 24.4 +/- 3.0, 11.5 +/- 1.4 months respectively, p=0.0006). When between curatively and non-curatively resected patients were compared, the MSD was statistically different (18.0 +/- 2.8 and 10.0 +/- 1.5 months, respectively, p=0.0415). In a multivariate survival analysis using Cox's proportional hazard model, Borrman's type and the presence of distant metastasis were clarifed a powerful prognostic factors with ratios of risk of 2.7579 and 1.8825, respectively. CONCLUSION: This study suggests a prognostic benefit for surgery in cases with resectability. Furthermore, we recommend subclassifing stage IV gastric cancer as stage IVa which has no distant metastasis and IVb which has distant metastasis, considering the significant survival difference between these two groups.

Clinicopathologic Correlation in IgA Nephropathy with Haas' Subclassification / 대한신장학회잡지

OBJECTIVES: IgA nephropathy is a common type of primary glomerulonephritis and may present with a wide variety of histologic patterns on renal biopsy. IgA nephropathy may progress to end stage renal disease. But it is difficult to predict the prognosis of IgA nephropathy. METHODS: In an attempt to identify prognostic indicators in this disease, the clinical data from 158 patients with IgA nephropathy were analyzed and compared to the pathologic subclassification proposed by Haas. RESULTS: 1)The mean age of 158 patients with IgA nephropathy was 31.5 yrs(M:F=1:1.04) and there were 17 patients in subclass I, 5 patients in subclass II, 80 patients in subclass III, 34 patients in subclass IV, 22 patients in subclass V. 2)The significant correlation between renal survival rate and histologic subclass in 114 patients who were followed-up for more than 12 months was showed in order of I, II>III, IV>V. 3)Active crescents were a significant negative prognostic indicator in renal survival in subclass III, but not in subclass IV. 4) The presence of immune complex deposits in the glomerular capillary loops in addition to the deposits in mesangial areas was associated with poor prognosis in progression to end stage renal disease of IgA nephropathy 5)With a respect to clinical presentation, hypertension, serum creatinine of>=1.5mg/dL, and proteinuria of>=2.0g/day were significant negative prognostic indicators for renal survival but the presense of gross hematuria was not associated with increased renal survival rate by an univariate analysis. CONCLUSION: These results suggest that histologic subclassification proposed by Haas may be a useful prognostic indicator for the clinical outcome of IgA nephropathy, as well as the amount of proteinuria, serum creatinine level and hypertension at the time of initial renal biopsy

A study on subclassification of AVS-penogram / 대한비뇨기과학회지

We have effectively used AVS-Penogram as the primary diagnostic method for impotence. In this study, we classified the types of curve on AVS-Penogram in detail and evaluated the origin of each of the classified types for 308 patients who were finally diagnosed by comprehensive diagnostic methods. Also we divided the unstable type into the multi-peak type and the one-peak type based on the number of peaks in the curve. and the delay type into the simple-delay type and the unstable-delay type based on whether there were fluctuations or not. After evaluating and considering the clinical significance of each of the curve type. we have reached the following conclusion. I. Type I group which is similar to normal control group was proved as psychogenic impotence in 86% of the patients. 2. The impossible type II A group was proved as organic impotence in 97% of the patients and most or them had neurogenic and arteriogenic impotence. 3. The unstable type II B group was proved as psychogenic impotence in 52% of the patients ;61% in the case of the multi-peak type, and 15% in the case of the one-peak type. The difference between both types were statistically significant. We think the one-peak type is more strongly related to organic cause, and in the case of the multi-peak type. further studies are needed for differential diagnosis between psychogenic and vasculogenic impotence, which were the most frequent types. 4. The delay type II C group was proved as psychogenic impotence in 4l% of the patients; 44% in the case of the simple-delay type, and 39% in the case of the unstable-delay type. There was no significant difference between these two types. In the case of the delay type, further studies are needed for differential diagnosis between psychogenic and arteriogenic impotence, which were the most frequent types. In conclusion, AVS-Penogram is a useful method in measurement of natural erotic erection and a primary diagnostic method in impotence, and it is an important differential diagnostic parameter to divide the unstable type into the multi-peak type and the one-peak type. Also in the case of the patient classified as multi-peak type, if more studies about neurotransmitter can be done, diagnostic methods from these studies can be developed. and the objective analysis of nocturnal penile enlargement can be achieved. new organic factor will be found in the patients proved to be psychogenic impotence.

Subdural Hematoma Associated with Dural Metastasis: A Case Report and Review of the Literature

The authors report a case of nontraumatic subdural hematoma associated with dural metastasis. We review the pathological and hematological features of this and 13 similar cases reported in the literature. Although rare, they have different pathological and hematological features. According to the pathological features, three types are subclassified and the presumptive pathogeneses are discussed.

Thin Acute Subdural Hematoma: Part 1 : Clinical Significance

A retrospective study on 107 cases of acute(within 24 hours) subdural hematoma(ASDH) with special reference to the size is presented. The thin ASDH is defined as the hematoma of which thickness is less than 3 mm in the printed CT film(true thickness about 10 mm). 45 cases are the thin ASDH and 62 cases are the not-thin ASDH. Age, Glasgow coma score, pupil, CT finding, operation finding, operation method, interval from injury to CT and operation, and outcome at 1 month are compared and analysed with chi square tests. The most significant difference is the high surgical mortality (92.6%) in the thin ASDH despite of the fact that there are no significant bad prognostic factors. This difference might be due to the fact that diffuse brain injury is more commonly associated with the thin ASDH and suggested that the thin ASDH should be managed differently from the not-thin ASDH.