Usefulness of 1H Magnetic Resonance Spectroscopy for Evaluation of Cognitive Impairment after Subarachnoid Hemorrhage Caused by Rupture of Middle Cerebral Artery Aneurysm

OBJECTIVE: To investigate the relationship between cognitive impairment and 1H magnetic resonance spectroscopy (1H MR spectroscopy) in patients with subarachnoid hemorrhage (SAH) caused by rupture of middle cerebral artery (MCA) aneurysm. METHOD: 1H MR spectroscopy was performed in 6 patients with SAH after rupture of MCA aneurysm and in 20 controls. Image-guided localized 1H MR spectra were obtained from left parietal white matter (PWM). The cognitive status was evaluated using the Mini Mental Status Examination (MMSE), and the scores were correlated with N-acetyl aspartate/creatine (NAA/Cr), choline/creatine (Cho/ Cr), and myoinositol/creatine (mI/Cr) metabolic ratios. RESULTS: NAA/Cr was significantly lower, and Cho/Cr was higher in SAH patients than in controls in the left PWM (p0.05). CONCLUSION: 1H MR spectroscopy could be helpful in the evaluation of cognitive impairment in SAH.

Neurodevelopmental Outcome in Children Born after in vitro Fertilization

OBJECTIVE: To investigate neurodevelopmental long-term outcome in children born after in-vitro fertilization (IVF). METHOD: We performed retrospective study in which we investigated development of neurodevelopmental disability in 254 childern (113 twins, 28 singletons) born after in vitro fertilization between Janurary 1995 and December 1999. We obtained neurodevelopmental status on a certain date and disability of children from medical records or phone interviews of parents. We assessed developmental status, congenital malformation, cerebral palsy and seizure, speech disorder, other neurologic problems, prematurity, low birth weight, maternal age, intraventricular hemorrhage (IVH), retinopathy and congenital anomaly. RESULTS: Six children (2.3%) were diagnosed as cerebral palsy, three children (1.2%) as developmental delay and 11 had IVH, 6 had retinopathy, 10 had congenital anomaly (esp. abdominal wall defect). The mean maternal age was 30+/-2.8 years old and gestational age was 35+/-3.0 weeks. One hundred one children (39.7%) were born prematurely, 66.5% low birth weight. CONCLUSION: High prevalence of neurodevelopmental disabilities like cerebral palsy compared to population controls (cerebral palsy: 1.9/1000 live birth) was revealed. Therefore, we should know mild high risk of developmental disability and do developmental examination carefully in children born after IVF and long-term follow up.

Preemptive Swallowing Stimulation in Long-term Intubated Patients

OBJECTIVE: To evaluate the effect of preemptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients. METHOD: Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2003 were randomly assigned to two groups. Fifteen patients were stimulated (experimental group), and 18 patients were not stimulated (control group). The duration of intubation was 15.5+/-6.7 days in the experimental group and 15.7+/-6.5 days in the control group. Duration of stimulation in the experimental group was 7.3+/-3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallowing study. RESULTS: There was no difference in percentage of aspiration and swallowed volume between two groups. Oral transit time of the experimental group (0.37+/-0.07 sec) was significantly shorter than that of the control group (0.83+/-0.10 sec), and the oropharyngeal swallowing efficiency of the experimental group (73.3+/-17.4%/sec) was significantly higher than that of the control group (50.1+/-13.0%/sec). CONCLUSION: Preemptive swallowing stimulation in long term intubated patients may facilitate recovery of dysphagia.

Effects of Intensive Early Rehabilitation Program in Postmastectomy Patients

OBJECTIVE: To investigate whether early postmastectomy rehabilitation program could improve shoulder function and upper limb edema. METHOD: 40 patients who underwent either a breast conserving procedure or a modified radical mastectomy were included. Among 40 patients, 20 patients recieved early postmastectomy rehabilitation program and 20 patients were recieved only instruction for exercise. The patients were assessed on the three days after surgery and one month after surgery. The range of motion (ROM) of shoulder, pain on mobility of shoulder and arm circumference were evaluated. RESULTS: One month after surgery, both groups showed improvements in shoulder motion range, pain and edema. But there were significantly better in early rehabilitation group than control group (p <0.05). CONCLUSION: We concluded that early postmastectomy rehabilitation program was beneficial in regaining the shoulder motion and in reduction of pain and edema.