Comparison of Early and Late Tuberculosis Deaths in Korea

The cause of death in patients with tuberculosis (TB) may differ according to the phase of anti-tuberculosis treatment. However, there are limited data regarding this issue in Korea. We compared the cause of death of TB patients who died during the early intensive and late continuation phase of treatment. Twenty (56%) of the 36 early deaths were due to TB-related causes, whereas 34 (89%) of the 38 late deaths were due to TB-unrelated causes. This finding suggests that TB-related early deaths mainly attributable to delayed diagnosis should be improved to further reduce the overall TB deaths.

A Case of Ovarian Mature Cystic Teratoma in Woman with Turner syndrome / 대한산부인과학회지

Ovarian tumors in patients with Turner's syndrome are extremely rare. Turner syndrome occurs in 1 of 4000 to 10,000 live births, giving an approximate incidence of 1 to 2,500 live female births. Approximately half of the patients with Turner syndrome have "pure" 45,X cells in peripheral blood lymphocytes. Thirty to forty percents of Turner syndrome patients present mosaicism: 10-15% of the total group are 45,X/46,XX and 2 to 5% are 45,X/46,XY. In 45,X/46,XY Turner syndrome, the risk of developing a tumor is as high as 15-25%, with the possible development of dysgerminoma or gonadoblastoma. Recently, we experienced a case of a very rare left ovarian mature cystic teratoma in a 45,X/46,XX Turner syndrome, so report with a brief review of literature.

A Case of Rectal Cancer in Pregnancy / 대한산부인과학회지

Colorectal cancer during pregnancy is rare condition associated with poor prognosis. The diagnosis is often delayed because the presenting symptoms of abdominal pain, nausea, vomiting, constipation, rectal bleeding and backache are commonplace in normal pregnancy. Management is individualized to each patient. If the tumor is discovered during first half of pregnancy, the treatment of the cancer should take priority and, if possible, immediate surgical resection should be performed. More often the tumor is discovered at the second half of pregnancy, delaying resection until postpartum is recommended allowing the fetus to develop to safe delivery. Thus, it is important not to underestimate the patient's symptoms because the early diagnosis is essential for better prognosis. We experienced a woman at 30 weeks gestation with adenocarcinoma of the perforated rectum diagnosed after emergency cesarean delivery with a brief review of literature.

A Case of Iniencephaly Diagnosed by Prenatal Ultrasonography / 대한산부인과학회지

Iniencephaly is an abnormality in cervical vertebra associated with an excessive lordosis of the cervicothoracic spine and neural tube closure defects. The incidence is one of 1,000 to 10,000 live birth. The pathogenesis is unknown. It is possible that iniencephaly is a primary defects in fetal cervical development and the resulting lordosis cause a failure of neural tube closure. Specific sonographic findings are over extended fetal head, very short and modified thorax, generally shortened fetal long bones and frequent associating anencephaly and meningomyelocele. Fetal alpha-fetoprotein elevation may be present. Iniencephaly, when diagnosed in utero, is almost always lethal. We experienced a case of iniencephaly in a fetus of intrauterine pregnancy at 17 weeks diagnosed by prenatal ultrasonography who was terminated because of ultrasonic demonstration of other multiple anomalies. Thus, we report a case with brief review of the literature.

A Case of Pericardial Effusion in Pregnant Woman with Hypothyroidism / 대한산부인과학회잡지

Because thyroid disorders have a predilection for young women, it is not surprising that they are encountered with some frequency during pregnancy. Additionally, there is evidence that changes induced by pregnancy may actually stimulate remission and exacerbation of preexisting thyroid disease. Hypothyroidism is diagnosed if the expected rise of circulating thyroxine level does not occur during pregnancy, and the level of thyrotropin is elevated. Some authors indicate that hypothyroid women who do become pregnant have a high incidence of preeclampsia and placental abruption with a correspondingly inordinate number of low birth- weight, stillborn infants, heart diseases of pericardial effusion, pleural effusion and so on. We report here a case of patient, 35-year-old pregnant woman who experienced pericardial and pleural effusions with hypothyroidism induced after total thyroidectomy. The patient was recovered with thyroxine replacement and conservative treatments.

The Exploratory Study for Medical Aptitude Constructs / 한국의학교육

PURPOSE: The aim of this study is to explore the individual traits needed for the successful performance of a doctor's duties as well as to establish primary criteria for the Medical Education Eligibility Test. METHODS: This study conducted qualitatively by interviewing 43 persons: medical school professors, residents, and medical reporters. The analysis of data were applied a content analysis. RESULTS: 1) The important intelligent abilities revealed were problem solving, verbal expression, and memory. 2) The personality traits included sincerity, sociability, respectability, gentleness, and reflective thinking. 3) The biology, chemistry, and physics were important in the natural science background knowledge, and 4) linguistics, philosophy, and social science were important in human and social science background knowledge. CONCLUSION: The medical aptitude could be constructed intelligent ability, personality trits, and background knowledges, and include specific aspects depended on Korean context.

Use of Laryngeal Mask Airway ProsealTM in a Total Thyroidectomy for Huge Thyroid Tumor: A case report / 대한구급학회지

This is a case of anesthesia for a 49 year old woman with huge thyroid tumor who was admitted for total thyroidectomy. General anesthesia for thyroidectomy has traditionally involved tracheal intubation. But, we failed orotracheal intubation as in ability to insert a tracheal tube from the oropharynx into the trachea. After laryngoscopy was attempted three times, a laryngeal mask airway ProSealTM (PLMATM), size 3, was requested. The device was passed easily, and a patent airway was obtained. During general anesthesia, patient was mechanically ventilated through the PLMATM to airway pressures of approximately 20 cmH2O and positive pressure ventilation without air leaks was possible. Total thyroidectomy was performed without hypoxia and hypercarbia.

Comparison of rCBF between Patients with Medial Temporal Lobe Epilepsy and Normal Controls using H215O PET / 대한핵의학회잡지

No abstract available.

The Maximal Changes of Vital Signs to Laryngeal Mask Airway ProSealTM (PLMA(TM)) Insertion or Tracheal Intubation after Anesthetic Induction in Hypertensive Patients / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the hemodynamic changes of insertion of a laryngeal mask airway ProSealTM (PLMATM) or tracheal intubation in hypertensive patients. METHODS: Twenty hypertensive patients, aged between 41 to 73 yrs, undergoing an elective surgery, were studied. All patients were allocated randomly to have their surgery performed with endotracheal intubation (Group ET, n = 10) or PLMA(TM) (Group PLMA, n = 10) and were studied for cardiovascular responses related to intubation or PLMA(TM) insertion. Anesthesia was induced with thiopental sodium and vecuronium intravenously. The lungs were then ventilated manually through a facemask with 1.0% enflurane in oxygen and maximal changes (%) in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) and heart rate (HR) were measured after tracheal intubation or PLMA(TM) insertion after anesthetic induction. RESULTS: The maximal changes (%) in SBP, DBP, MBP and HR were less in Group PLMA than in Group ET during the observation period (SBP: 7.2 +/- 6.8 vs 55.7 +/- 5.7, DBP: 7.3 +/- 6.3 vs 47.5 +/- 8.3, MBP: 7.9 +/- 6.9 vs 50.5 +/- 5.7, HR: 10.8 +/- 7.2 vs 48.2 +/- 6.1, P < 0.05). CONCLUSIONS: PLMA(TM) insertion elicited less hemodynamic change than tracheal intubation in hypertensive patients.

Evaluation of Safety and Usability of Low Pressure Carbon Dioxide Insufflation in Endoscopic Thyroidectomy / 대한마취과학회지

BACKGROUND: Carbon dioxide insufflation during an endoscopic thyroidectomy may cause an adverse effects on blood gas and hemodynamic status. This study was conducted to evaluate the safety of low pressure carbon dioxide insufflation during an endoscopic thyroidectomy. METHODS: Patients in ASA physical status I or II, scheduled for an endoscopic thyroidectomy (n = 70) were gathered for the evaluation. During the operative procedure, minute ventilation at a tidal volume 10 ml/kg and respiratory rate 10/minute was maintained. End-tidal carbon dioxide tension, blood pressure and heart rate were measured and compared before and at 10, 20, 30, 60 and 90 minutes after CO2 insufflation. RESULTS: End tidal carbon dioxide tension significantly increased up to 30 minutes and plateaued thereafter. Mean blood pressure significantly increased up to 30 minutes but there was no change in heart rate after CO2 insufflation. Complications were not reported. CONCLUSIONS: We concluded that low pressure carbon dioxide insufflation during an endoscopic thyroidectomy was safe and useful.

Unusual Acute Encephalitis Involving the Thalamus: Imaging Features

OBJECTIVE: To describe the brain CT and MR imaging findings of unusual acute encephalitis involving the thalamus. MATERIALS AND METHODS: We retrospectively reviewed the medical records and CT and/or MR imaging findings of six patients with acute encephalitis involving the thalamus. CT (n=6) and MR imaging (n=6) were performed during the acute and/or convalescent stage of the illness. RESULTS: Brain CT showed brain swelling (n=2), low attenuation of both thalami (n=1) or normal findings (n=3). Initial MR imaging indicated that in all patients the thalamus was involved either bilaterally (n=5) or unilaterally (n=1). Lesions were also present in the midbrain (n=5), medial temporal lobe (n=4), pons (n=3), both hippocampi (n=3) the insular cortex (n=2), medulla (n=2), lateral temporal lobe cortex (n=1), both cingulate gyri (n=1), both basal ganglia (n=1), and the left hemispheric cortex (n=1). CONCLUSION: These CT or MR imaging findings of acute encephalitis of unknown etiology were similar to a combination of those of Japanese encephalitis and herpes simplex encephalitis. In order to document the specific causative agents which lead to the appearance of these imaging features, further investigation is required.

Functional Mapping of the Neural Basis for the Encoding and Retrieval of Human Episodic Memory Using H215O PET / 대한핵의학회잡지

PURPOSE: Episodic memory is described as an 'autobiographical' memory responsible for storing a record of the events in our lives. We performed functional brain activation study using H215O PET to reveal the neural basis of the encoding and the retrieval of episodic memory in human normal volunteers. MATERIALS AND METHODS: Four repeated H215O PET scans with two reference and two activation tasks were performed on 6 normal volunteers to activate brain areas engaged in encoding and retrieval with verbal materials. Images from the same subject were spatially registered and normalized using linear and nonlinear transformation. Using the means and variances for every condition which were adjusted with analysis of covariance, t-statistic analysis were performed voxel-wise. RESULTS: Encoding of episodic memory activated the opercular and triangular parts of left inferior frontal gyrus, right prefrontal cortex, medial frontal area, cingulate gyrus, posterior middle and inferior temporal gyri, and cerebellum, and both primary visual and visual association areas. Retrieval of episodic memory activated the triangular part of left inferior frontal gyrus and inferior temporal gyrus, right prefrontal cortex and medial temporal area, and both cerebellum and primary visual and visual association areas. The activations in the opercular part of left inferior frontal gyrus and the right prefrontal cortex meant the essential role of these areas in the encoding and retrieval of episodic memory. CONCLUSION: We could localize the neural basis of the encoding and retrieval of episodic memory using H215O PET, which was partly consistent with the hypothesis of hemispheric encoding/retrieval asymmetry.

A Case of Bilateral Anterior Opercular Syndrome: Foix-Chavany-Marie Syndrome

Bilateral opercular syndrome or Foix-Chavany-Marie syndrome (FCMS) is characterized by facio-pharyngo-glosso-masticatory diplegia with an automatic-voluntary movement dissociation, which is usually caused by bilateral fron-toparietal opercular lesions. A 52 year-old man suddenly developed left hemiplegia and also presented with anarthria, dysphagia, difficulty in jaw opening and mastication. However, involuntary swallowing and slight control of jaw move-ments were partly preserved. His gag reflex was decreased and emotional incontinence was absent. Brain magnetic res-onance (MR) imaging revealed high signal lesions in the right middle cerebral artery territory and left anterior opercu-lum. Severe stenosis of the right middle cerebral artery was observed on a MR angiogram. Rehabilitation training by cueing has improved his ability to open the mouth. To our knowledge, this is the first report of FCMS in Korea, and a cautious differential diagnosis of pseudobulbar palsy or buccofacial apraxia may be crucial.

Effect of Material-specificity on the Wada Memory Test in Medial Temporal Lobe Epilepsy with Hippocampal Sclerosis

BACKGROUNDS: The Wada test is a useful method in predicting the laterality of a epileptogenic zone. However, past research reveals that material specificity has an influence on the lateralization We examined the material-specificity of memory and its change in epileptic patients to discover reasonable items on the Wada test for the proper lateralization of the epileptogenic zone. METHODS: We analyzed 45 patients with video-EEG-confirmed medial temporal lobe epilepsy (mTLE) and definite hippocampal atrophy by an MRI. Eight items were presented during the Wada test including 3 common objects, 1 geometric object, 1 color, 1 word, 1 phrase, and 1 math expression. We checked recognition memo-ry after recovery of hemiparesis and normalization of EEG. RESULTS: For the right mTLE group, recognition memory following a right hemisphere injection was significantly better than a left hemisphere injection for all categories. For the left mTLE group, a significant difference of scores was found for the left versus right hemisphere injection for common objects. When injected to the left hemisphere, all the items helped lateralization, but when injected to the right hemisphere, a phrase did not help with lateralization. CONCLUSIONS: Items with strong unilateral encodings do not help lateralizing the epileptogenic zone.

Disconnection Syndrome in Acute Hydrocephalus due to Intraventricular Hemorrhage

The right and left hemispheres of the brain play somewhat different roles but help each other perform higher cortical functions. A 43 year-old right-handed woman was admitted due to a intraventricular hemorrhage followed by hydro-cephalus. A brain MRI revealed an intraventricular hemorrhage in the lateral, 3rd, and 4th ventricle and the hemorrhage in the lateral ventricle was compressing the genu of the corpus callosum. When asked to draw the face of a clock, she placed the numbers in reverse order (counter clockwise) when performing the task with her right hand, whereas the same task performed by the left hand was normal. In addition, when she wrote out simultaneously with right and left hands , she wrote Korean words in their mirror image with her left hand . When she wrote Chinese characters, she performed better with her right hand. These findings revealed some aspects of interhemispheric interaction in processing the images of a clock, and the orthographic lexicon of Korean and Chinese characters.

The Clinical Usefulness of Ictal Surface EEG in Neocortical Epilepsy

BACKGROUND: Localizable scalp ictal EEG appears to be rare in neocortical epilepsy. However, there have not been many studies based upon a large number of patients. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic foci. METHODS: We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded by video-EEG monitoring systems with electrodes placed according to the international 10-20 system including additional anterior temporal electrodes. Ictal recordings were analyzed accord-ing to the localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured. RESULTS: The percentage of discrete or regional EEGs were respectively 26, 52, 70, and 10% in frontal lobe epilepsy (FLE), lateral temporal lobe epilepsy, occipital lobe epilepsy (OLE), and parietal lobe epilepsy (PLE). The ictal rhythms in the order of frequency were theta, delta, beta, alpha, and rhythmic spike-and-wave. The duration of discrete or regional ictal rhythms were significantly shorter in FLE and PLE than in other epilepsies. Ictal beta activ-ity was the most common rhythm in discrete-patterned EEGs. There were some tendencies of poor lateralization in the presence of structural lesion. Types of seizure were not related with the degree of localization except for simple partial seizure. CONCLUSIONS: Ictal surface EEG was clinically helpful in the localization of epileptogenic foci especially in particular neocortical epileptic syndromes.

Functional Brain Mapping Using H2 15O Positron Emission Tomography ( II ): Mapping of Human Working Memory / 대한핵의학회잡지

PURPOSE: To localize and compare the neural basis of verbal and visual human working memory, we erforrned functional activation study using H2O PET. MATERIALS AND METHODS: Repeated H213O PET scans with one control and three different activation tasks were performed on six right-handed narmal volunteers. Each activation task was composed of 13 matching trials. On each trial, four targets, a fixation dot and a probe were presented sequentially and subjects task was to press a response button to indicate whether or nat the probe was one of the previous targets. Short meaningful Korean words, simple drawings and monochromic pictures of human faces were used as matching objects for verbal or visual memory. All the images were spatially normalized and the differences between control and activation states were statistically analyzed using SPM96. RESULTS: Statistical analysis of verbal memory activation with short words showed activation in the left Broca's area, premotor cortex, cerebellum and right cingulate gyrus. In verbal memory with simple drawings, activation was shown in the larger regions including where activated with short words and left superior temporal cortex, basal ganglia, thalamus, prefrontal cortex, anterior portion of right superior temporal gyrus and right infero-lateral frontal cortex. On the other hand, the visual memory task activated predominantly right-sided structures, especially inferior frontal cortex, supplementary motor cortex and superior parietal cortex. CONCLUSION: The results are :consistent with the hypothesis of the laterality and dissociation of the verbal and visual workmg memory from the invasive electrophysiological studies and emphasize the pivotal role of frontal cortex and cingulate gyrus in working memory system.

Comparative Add-on Trial of Vigabatrin and Valproic Acid on Intractable Partial Seizures with Carbamazepine Monotherapy

PURPOSE: To evaluate the efficacy of vigabatrin and valproic acid add-on therapy in the treatment of uncontrolled partial-onset seizures through randomized active controlled parallel-group trial. METHODS: Criteria for entry included a requirement for three or more partial seizures per month despite the blood level of carbamazepine was within therapeutic range. During the 56-day baseline period, patients had at least 6 partial onset seizures. Vigabatrin or valproic acid were administered as the second drug in a randomized fashion. RESULTS: Forty one patients completed the trial(21 for vigabatrin, 20 for valproic acid). There is no statistically significant difference in age, age at onset, baseline seizure frequency, dose of carbamazepine, and serum level of carbamazepine between two groups. Two patients of vigabatrin-treated group and three patients of valproic acid treated group were dropped out because of side effects. The mean vigabatrin and valproic acid does were 2809 and 1490 mg, respectively. The percentage of patients achieving at least a 50% reduction in seizure frequency at the end of 8-week of add-on trial was 62% among vigabatrin-treated patients and was 50% for patients who received valproic acid(not statistically different). There was no significant difference in seizure reduction, percent seizure reduction, and truncated percent seizure reduction between two groups. The side effects were mild and transient neurotoxic symptoms in the patients who completed the trial(5 patients for vigabatrin, 10 patients for valproic acid). CONCLUSIONS: This trial indicates that vigabatrin and valproic acid are safe and effective in the treatment of intractable partial-onset seizures. The efficacy of vigabatrin as a new add-on antiepileptic drug is comparable to the previous valproic acid carbamazepine combination in the sense of seizure reduction and maybe even superior to that in the consideration of side effects

The Usefulness of Ictal SPECT in Preoperative Localization of Neocortical Epileptic Foci

RATIONALE: Studies on ictal SPECT as a method of presurgical evaluation in neocortical epilepsy have been rare and inadequate. We evaluated the accuracy in the localization of epileptic foci with ictal SPECT in neocortical epilepsy and tried to find out the determining factors of its accuracy. METHODS: We performed ictal SPECT 66 times with 99m-Tc-HMPAO in 56 patients, who received video-EEG monitoring and had electroclinical features of neocortical epilepsy. Invasive monitoring was performed in 28 patients & epileptic surgery was done in 31. Their results were also used to help determine the location of epileptic foci. In 54 of 66 scans data about injection time and temporal relationship of HMPAO injection to the onset and secondary generalization of seizures were available. RESULTS: Frontal lobe epilepsy(FLE) was most common(35%) followed by lateral temporal lobe epilepsy(28%), occipital lobe epilepsy(11%), parietal lobe epilepsy(9%), and etc. Ictal SPECT demonstrated unilateral hyperperfusion in 53 of 66 scans (80.3 %) which were concordant with electroclinical lateralization in 48 of 53 (90.6 %). Localized hyperperfusion was evident in 42 of 66 scans (63.6 %) which were concordant with electroclinical localization in 33 of 42(78.6 %). Correctly localized hyperperfusion or correctly-lateralized but diffuse hyperperfusion were detected in 37 of 54 scans in which data about injection time were available. The mean injection time was 32.1 seconds. In 16 scans ictal SPECT showed no hyperperfusion or falsely localized/lateralized hyperperfusion. Their mean injection time was 41.6 seconds. The difference of injection time between two groups was not significant(p-value=0.07), but there was a tendency that the mean injection time of the former group was earlier than that of the latter group. We had chances to perform ictal SPECT repeatedly in 8 patients under the similar conditions. The fact that earlier injection improved the accuracy of ictal SPECT in 6 patients supports the importance of early injection. In 48 studies with ictal injection, only 11 scans gave no or incorrect information of the localization or lateralization of epileptic foci. But, in 6 studies with postictal injection, 5 scans was not helpful. The difference between two groups was statistically significant(p<0.05). The presence of focal lesion, the location of epileptic foci, or secondary generalization did not influence the accuracy of ictal SPECT. CONCLUSIONS: Our data suggest that ictal SPECT in neocortical epilepsy is useful in localization of epileptic foci. Whether injected ictally or postictally and the injection time from seizure onset seems to influence the accuracy of ictal SPECT in neocortical epilepsy.

Relationship between Functional Lateralization by Interictal Cerebral 18-FDG PET and by Intracarotid Amobarbital Procedure in Temporal Lobe Epilepsy

BACKGROUND: Many studies have reported that intracarotid amobarbital procedure (IAP) and 18-FDG PET of the brain are tests for focal functional integrity used in preoperative evaluation of temporal lobe epilepsy (TLE). And these tests have been used for assisting in lateralization of the epileptogenic focus. OBJECTS: We wanted to determine the relationship between functional lateralization by PET and by IAP and the role of those tests for lateralization in patients with TLE. METHODS & PATIENTS: All patients underwent long-term video/EEG monitoring, MRI of the brain, 18-FDG PET, IAP and some patients also had invasive EEG monitoring. The side of the epileptogenic focus was determined by interictal and ictal EEG, ictal semiology, SPECT, and MRI of the brain. Patients with mass lesion were excluded. Twenty seven had epileptogenic focus in the right temporal lobe and twenty six in the left temporal lobe. RESULTS: PET showed temporal lobe hypometabolism ipsilateral to the epileptogenic focus in 90% (48 of 53). Two patients showed bilateral temporal hypometabolism and two did normal findings. But these four patients showed Ipsilateral memory impairment to the epileptogenic focus in IAP. IAP revealed ipsilateral memory impairment to the epileptogenic focus in 70% (37 of 53) patients. Fifteen patients (28%, 15 of 53) showed ipsilateral temporal hypometabolism to the epileptogenic focus. Only one patient showed contralateral memory impairment to the epileptogenic focus but bilateral hypometabolism in PET. CONCLUSION: We find the convergence of data from MRI, EEG, IAP and PET to be very helpful in selection process of patients for temporal lobectomy.