Cheyne-Stokes Respiration and Prognosis in Neurocritical Patients

Objectives@#Cheyne-Stokes respiration (CSR) is frequently found in critically ill patients and is associated with poor prognosis. However, CSR has not been evaluated in neurocritical patients. This study investigated the frequency and prognostic impact of CSR in neurocritical patients using biosignal big data obtained from intensive care units. @*Methods@#This study included all patients who received neurocritical care at the tertiary hospital from January 2018 to December 2019. Clinical information and biosignal data of intensive care units were used and analyzed. The respiratory curve was visually assessed to determine whether CSR and obstructive sleep apnea (OSA) were present, and a heart rate variability (HRV) was obtained from the electrocardiogram. @*Results@#CSR was confirmed in 166 of 406 patients (40.9%). Patients with CSR were older, had a higher frequency of cardiovascular risk factors as well as heart failure, and had a poor outcome (modified Rankin scale ≥4). As a result of multiple regression analysis adjusted for other variables, CSR was significantly associated with poor outcome with an odds ratio of 2.27 times higher (95% confidence interval 1.25–4.14, p=0.007). HRV analysis demonstrated that CSR and OSA had distinct autonomic characteristics. @*Conclusions@#This study first revealed the substantial frequency of CSR in neurocritical patients and suggests that it can be used as a predictor of poor prognosis in neurocritical care.

Comorbid Depression Is Associated with a Negative Treatment Response in Idiopathic REM Sleep Behavior Disorder

Background@#and PurposeThe first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD). @*Methods@#We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0±7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25–0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment. @*Results@#Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15–12.32, p=0.029). @*Conclusions@#We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.

Delayed Diagnosis of Chromosome 22q11.2 Deletion Syndrome Due to Late-Onset Generalized Epilepsy

No abstract available.

Effects of Transcranial Direct-Current Stimulation Therapy on Primary Chronic Insomnia: A Proof-of Concept Clinical Trial

OBJECTIVES: To assess the effect and safety of transcranial direct-current stimulation (tDCS) in primary chronic insomnia. METHODS: A one-month, double-blind, randomized, sham-controlled trial was performed. A total of 7 patients with primary chronic insomnia received tDCS using anodal (n=3), cathodal (n=2), or sham stimulation (n=2). They were followed up at 1 week and 1 month after treatment. The primary outcome measures included improvement in total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) at 1 month follow-up. RESULTS: TST and SE were improved with tDCS at 1 month follow-up in all patients (100%) of the anodal group, one (50%) of the cathodal group, and one (50%) of the sham group. tDCS improved SL at 1 month follow-up in two patients (67%) of the anodal group, one (50%) of the cathodal group, and none (0%) of the sham group. With respect to adverse events, transient itching sensation occurred in one patient of the anodal group. None of the other groups reported adverse events. CONCLUSIONS: Our results suggest that tDCS may be effective and safe for treatment of primary chronic insomnia. A larger controlled study needs to be further investigated.

Cardiac Activation Associated with Non-Periodic Leg Movements in Comparison to Periodic Leg Movements during Sleep in Patients with Restless Legs Syndrome and Healthy Subjects

OBJECTIVES: Periodic leg movements in sleep (PLMS) are associated with arousals and autonomic activation, which may contribute to higher cardiovascular disease risk in patients with restless legs syndrome (RLS). Non-periodic leg movements in sleep (NPLM) are leg jerks in sleep that does not satisfy standard criteria of PLMS. The aim of this study was to evaluate impact of short-interval leg movements in sleep (SILMS) and isolated leg movements in sleep (ILMS) in comparison to PLMS on heart rate in both patients with RLS and healthy controls. METHODS: Seven idiopathic RLS patients and 9 controls were enrolled in this study. Polysomnographic studies were analyzed and leg movements (LM) were automatically detected. NPLM can be classified as SILMS and ILMS. SILMS are LM separated by an inter-movement interval (IMI) shorter than 10 s, and ILMS are LM with IMI longer than 90 s. Frequency and heart rate associated with SILMS, ILMS, and PLMS in RLS patients were compared to those in controls. Heart rate change associated with LM were determined for a fixed time window. RESULTS: Frequencies of SILMS and ILMS of patients with RLS were not significantly different to those of controls. RLS patients presented higher heart rate change associated with SILMS than PLMS before movement onset, while heart rate change associated with SILMS, ILMS, and PLMS were not different in the controls. CONCLUSIONS: Although the number of SILMS is not higher than PLMS, SILMS may have closely associated with higher cardiac activation of RLS than PLMS. Therefore, SILMS might be an important treatment target for patients with RLS to reduce long-term cardiovascular risk. Long-term prospective studies are needed to evaluate the relationship between NPLM and cardiovascular disease in patients with RLS.

Case of Rickettsia typhi-induced Brain Abscess Mimicking Brain Tumor

Murine typhus is one of the most prevalent rickettsial infections in the world, caused by the bacterial genus Rickettsia. Though the disease manifests a relatively benign clinical course with fever, rash, and headache being the 3 classic symptoms, neurological complications may arise in patients that could become permanent. In this case study, a patient with a brain abscess caused by R typhi infection is described. Based upon the recent reemergence of arthropod-borne disease, the findings in this case are significant; R typhi can cause a brain abscess that mimics a brain tumor, which delays the diagnosis and appropriate management of the disease. Murine typhus should always be considered when performing the differential diagnosis of brain abscesses in South Korea.

Differential Effect of Light Emitting Diode Light on Electroencephalographic Oscillations in Young and Old Healthy Subjects

OBJECTIVES: To investigate brain oscillatory characteristics according to brightness and color temperature of light emitting diode (LED) light in young and elderly subjects. METHODS: We analyzed 22 young (age, 29.0±5.2 years) and 23 elderly (age, 64.8±4.5 years) healthy subjects. A LED light source was used with a combination of two color temperature (6,500 K vs. 3,000 K) and two brightness (700 lx vs. 300 lx) conditions. Participants were exposed to each light condition in relaxed wakefulness. Then, we analyzed power spectral density and functional connectivity from eye-open electroencephalography. RESULTS: A main effect of brightness on delta (p=0.044) and theta (p=0.038) power was significant in the elderly subjects. Bright light enhanced delta and theta power in the frontal region. By contrast, power spectral density of young subjects was affected by color temperature; high color temperature significantly increased beta-band power of the central region (p=0.034). Regarding functional connectivity, a significant effect of color temperature was observed in delta (p=0.006) and beta (p=0.046) frequencies. High color temperature light enhanced beta connectivity of young subjects (p=0.007), while not affecting that of elderly subjects (p=0.979). CONCLUSIONS: The present study demonstrated that spectral power and functional connectivity as well as subjective feelings are affected by the brightness and color temperature of LED light. These results might help us to understand the neurophysiological effects of light and identify the optimal indoor lighting conditions for an individual's environment.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Korea: Clinical Features, Treatment, and Outcome

BACKGROUND AND PURPOSE: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune synaptic encephalitis and it often responds to treatment. We analyzed the clinical characteristics of anti-NMDAR encephalitis in Korea. METHODS: Serum and/or cerebrospinal fluid (CSF) of adult patients (aged > or =18 years) with encephalitis of undetermined cause were screened for anti-NMDAR antibodies using a cell-based indirect immunofluorescence assay. The patients came from 41 university hospitals. RESULTS: Of the 721 patients screened, 40 were identified with anti-NMDAR antibodies and clinical details of 32 patients were obtained (median age, 41.5 years; 15 females). Twenty-two patients (68.8%) presented with psychiatric symptoms, 16 (50%) with seizures, 13 (40.6%) with movement disorders, 15 (46.9%) with dysautonomia, 11 (34.4%) with memory disturbance, and 11 (34.4%) with speech disturbance. Magnetic resonance imaging, electroencephalography, and CSF examinations yielded nonspecific findings. Tumor information was only available for 22 patients: 5 patients had tumors, and 2 of these patients had ovarian teratomas. Twenty-two patients received immunotherapy and/or surgery, and therapeutic responses were analyzed in 21 patients, of which 14 (66.7%) achieved favorable functional outcomes (score on the modified Rankin Scale of 0-2). CONCLUSIONS: This study investigated the clinical characteristics of adult anti-NMDAR encephalitis in Korea. Currently, elderly patients who do not have tumors are commonly diagnosed with this condition. Understanding the detailed clinical characteristics of this disease will improve the early detection of anti-NMDAR encephalitis in patients both young and old.

Acute hyperkalemia induced by hyperglycemia in non-diabetic patient / 대한마취과학회지

No abstract available.

Cervical Epidural Anesthesia for Arteriovenous Bridge Graft at Upper Arm in Chronic Renal Failure Patients

PURPOSE: Cervical epidural analgesia is used for pain control in head and neck or upper arm. But it is not commonly used for the purpose of pure regional anesthesia for upper arm surgery. Therefore, we investigated the usefulness of cervical epidural anesthesia (CEA) as a method of regional anesthesia for arteriovenous bridge graft (AVBG) for hemodialysis at upper arm and evaluated the effects of CEA on hemodynamics and respiration. METHODS: One hundred-fifty chronic renal failure patients scheduled for AVBG were randomly assigned. In the sitting position, an epidural catheter was inserted at C6-7 or C7-T1 and 15 ml of 0.375% ropivacaine with fentanyl 20microg was injected. Analgesic level, blood pressure and heart rate were measured at 5-minute intervals after injection of the drug. Arterial blood sampling was taken for aBGA before and twenty minutes after CEA. RESULTS: Average anesthetic dermatomalsensory levels were C3.4+/-1.2~T5.7+/-2.8. During surgery, hypotension was noted in 49% of patients. It was treated with ephedrine or phenylephrine i.v. Baseline PaCO2 changed from 42.4+/-2.9 mmHg to 44.6+/-3.6 mmHg. CONCLUSION: The above results suggest that CEA is suitable for AVBG at upper arm as a regional anesthesia.

Comparison Study of Physical Properties between Two Silicone Gel Sheets

PURPOSE: Silicone gel sheet(SGS) is used for preventing and treating keloid or hypertrophic scars. Because the product is weak in tear strength and adherence, it requires several replacements, which requires high cost. As a solution for this problem, we developed a new silicone gel sheet, named as Scar Clinic, and confirmed its physical properties. METHODS: Tensile strength, elongation rate, adhesiveness, and water vapor transmission rate were experimentally compared between the most commonly used SGS product and the Scar Clinic. RESULTS: The newly developed SGS showed better results compared to the existed SGS in regards to tensile strength, elongation rate, adhesiveness, and water vapor transmission rate. CONCLUSION: The Scar Clinic showed higher durability and flexibility. It will be a useful product for treating scars clinically.

Pituitary Adenoma Accompanying Sphenoidal Meningoencephalocele with Clival Extension

Encephaloceles are known as rare craniofacial developmental anomalies which are herniation of cranial contents through a skull defect. Sphenoidal meningoencephalocele represents an important cause of reVersible visual loss. We report a rare case of pituitary adenoma accompanying sphenoidal meningoencephalocele with clival extension. Although the definitive diagnosis of cystic lesions in the sellar region before surgery is difficult, accurate diagnosis of these lesions is important to determine the type of treatment and predict prognostic outcome.

Pituitary Adenoma Accompanying Sphenoidal Meningoencephalocele with Clival Extension

Encephaloceles are known as rare craniofacial developmental anomalies which are herniation of cranial contents through a skull defect. Sphenoidal meningoencephalocele represents an important cause of reVersible visual loss. We report a rare case of pituitary adenoma accompanying sphenoidal meningoencephalocele with clival extension. Although the definitive diagnosis of cystic lesions in the sellar region before surgery is difficult, accurate diagnosis of these lesions is important to determine the type of treatment and predict prognostic outcome.

3 Cases of Spontaneous Pregnancies and Deliveries in Turner's syndrome / 대한산부인과학회잡지

Spontaneous pregnancy in Turner's syndrome is very rare because of ovarian dysgenesis and subsequent streak gonads. Recently we experienced 3 cases of pregnancies and deliveries in Turner's syndrome, so we report with a brief review of literature.

Significance of Intraoperative BAEPs Monitoring during Microvascular Decompression Surgery

No abstract available.

Fatal Complications Following to Epidural Steroid Injections for Lumbago and Sciatica: A Case Report

No abstract available.

A CLINICAL STUDY OF CHANGES IN GONIAL ANGLE BETWEEN PRE- AND POST-ORTHOGNATHIC SURGERY IN MANDIBULAR PROGNATHIC PATIENTS

The main goal of the surgical treatment of maxillofacial deformity is improved esthetic appearance and masticatory function. Recently, the purpose of orthognathic surgery has been focused on esthetic improvement of the patients. The purpose of this study was to investigate the changes in gonial angle to orthognathic surgery. For this study 30 patients were randomly selected. All patients with mandibular prognathism were operated upon with bilateral sagittal split ramus osteotomy and mandibular setback. The patients were cephalmetric lateral radiographs for 1 hear. Lateral cephalmetric radiographs taken preoperatively, over 6-months and 1 year follow up were traced and analysed. The following conclusions were reached. : 1. During following up period for 1 year, the change of gonial angle after orthognathic surgery was decreased, except 3 cases. The mean gonial angle change was decreased from 128.6 degrees(+/-4.83) to 123.4 degrees(+/-5.52) in female(p<0.05). 2. During follow up period for 1 year, the mean gonial angle was decreased after orthognathic surgery from 129.7 degrees(+/-6.47) to 123.3 degrees(+/-7.52), in all male patients(p<0.05). 3. The mean gonial angle changes after orthognathic surgery was about 5.2 degrees in female and 5.4 degrees in male. There was less statistical significance between male and female. 4. The ratio of mandibular setback amount from 6mm to 15mm was 83.3%, and from 1mm to 5mm was 10%.

LOWER LIP RECONSTRUCTION WITH BARREL-SHAPED EXCISION

No abstract available.

A case of carcinoma originating from aberrant breast tissue / 대한암학회지

No abstract available.

Evaluation of R Wave Amplitude Changes on Treadmill Exercise Testing

For the evaluation of exercise induced R wave amplitude changes in lead V5 (big up tri, openR) and multiple leads(summation operatorR), we studied 20 normal subjects and 21 ischemic heart disease patients with positive exercise test. All underwent submaximal, multiple leads multistage treadmill exercise testing. 14 to 20 normal subjects(70%) there were decreased R wave amplitude in multiple leads on treadmill exercise testing. 16 of 21 patients(76%) there were increased R wave amplitude on treadmill exercise testing. In normal group, R wave amplitude between rest and exercise was significantly decreased in lead V5 and multiple leads. In patients grous, R wave amplitude between rest and exercise was significantly increased in lead V5 and multiple leads. It is suggested exercise induced R wave amplitude changes probably enhance the diagnostic reliability by ST segment changes on treadmill exercise testing.