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Objective The aim of this study was to examine the change in the hippocampal volume and shape in early-onset mild cognitive impairment (EO-MCI) associated with the APOE e4 carrier state. Methods This study had 50 subjects aged 55-63 years, all of whom were diagnosed with MCI at baseline via the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. The EO-MCI patients were divided into the MCI continued (MCIcont) and Alzheimer's disease (AD) converted (ADconv) groups 2 years later. The hippocampal volume and shape were measured for all the subjects. The local shape analysis (LSA) was used to conduct based on the 2-year-interval magnetic resonance imaging scans. Results There was a significant correlation between APOE e4 allele and hippocampal volume atrophy. Over two years, the volume reduction in the left hippocampus was found to be faster than that in the right hippocampus, especially in the APOE e4 carriers. LSA showed that the 2 subfields were significantly affected in the left hippocampus. Conclusion These results suggest that the possession of APOE e4 allele may lead to greater predilection for left hippocampal atrophy in EO-MCI, and some specific subfields of the hippocampus may be more prominently involved.

The purpose of this study is to investigate differences in and correlations between cognitive abilities and brain volumes in healthy control (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD) groups. The Korean Version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K), which is used to diagnose AD, was used to measure the cognitive abilities of the study subjects, and the volumes of typical brain components related to AD diagnosis-cerebrospinal fluid (CSF), gray matter (GM), and white matter (WM)-were acquired. Of the CERAD-K subtests, the Boston Naming Test distinguished significantly among the HC, MCI, and AD groups. GM and WM volumes differed significantly among the three groups. There was a significant positive correlation between Boston Naming Test scores and GM and WM volumes. In conclusion, the Boston Naming Test and GM and WM brain volumes differentiated the three tested groups accurately, and there were strong correlations between Boston Naming Test scores and GM and WM volumes. These results will help to establish a test method that differentiates the three groups accurately and is economically feasible.

BACKGROUND AND PURPOSE This study investigates 36 subjects aged 55-65 from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database to expand our knowledge of early-onset (EO) Alzheimer's Disease (EO-AD) using neuroimaging biomarkers. METHODS Nine of the subjects had EO-AD, and 27 had EO mild cognitive impairment (EO-MCI). The structural ADNI data were parcellated using BrainParser, and the 15 most discriminating neuroimaging markers between the two cohorts were extracted using the Global Shape Analysis (GSA) Pipeline workflow. Then the Local Shape Analysis (LSA) Pipeline workflow was used to conduct local (per-vertex) post-hoc statistical analyses of the shape differences based on the participants’ diagnoses (EO-MCI+EO-AD). Tensor-based Morphometry (TBM) and multivariate regression models were used to identify the significance of the structural brain differences based on the participants’ diagnoses. RESULTS The significant between-group regional differences using GSA were found in 15 neuroimaging markers. The results of the LSA analysis workflow were based on the subject diagnosis, age, years of education, apolipoprotein E (e4), Mini-Mental State Examination, visiting times, and logical memory as regressors. All the variables had significant effects on the regional shape measures. Some of these effects survived the false discovery rate (FDR) correction. Similarly, the TBM analysis showed significant effects on the Jacobian displacement vector fields, but these effects were reduced after FDR correction. CONCLUSIONS These results may explain some of the differences between EO-AD and EO-MCI, and some of the characteristics of the EO cognitive impairment subjects.

Reported herein is a case of recurrent major depression with impulse control difficulty in a 33-year-old man with Dandy-Walker variant. He was diagnosed as having major depressive disorder a year before he presented himself to the authors' hospital, and had a history of three-time admission to a psychiatric unit in the previous 12 months. He was readmitted and treated with sodium valporate 1,500 mg/day, mirtazapine 45 mg/day, and quetiapine 800 mg/day during the three months that he was confined in the authors' hospital, and the symptoms were reduced within three months but remained thereafter. This is the only case so far reporting recurrent depression with impulse control difficulty associated with Dandy-Walker variant. This case implies that any cerebellar lesion may cause the appearance of recurrent depression with impulse control difficulty in major depressive disorder.

This study evaluated the anatomic significance and sites of aortic bifurcation, right renal artery, and conus medullaris when locating lumbar vertebral segments on MRI. SUBJECTS AND METHODS. The study group was composed of 210 patients who underwent MRI of the lumbosacral spine. The position of aortic bifurcation was evaluated using MRI. Midline and sagittal MRI were also assessed to identify the proximal portion of the right renal artery and the tip of the conus medullaris. These locations were recorded in relation to the upper or lower half of the adjacent vertebral body or the adjacent intervertebral disk space.The most common site of aortic bifurcation was at the L4 vertebra (83%). In most patients two separated iliac arteries were apparent at the level of the L4-L5 disk space (93%), and the right renal artery was located between the lower half of the L1 vertebra and the upper half of the L2 vertebra (92%). The position of the conus medullaris was variably located, and the most frequent site was at the L1 vertebra (56%).The aortic bifurcation, the right renal artery, and the combination of these structures can be reliable landmarks for determining the lumbar vertebral segments on MRI or CT. However, conus medullaris cannot be considered a good landmark because of its variable locations.

Purpose:It is critical that the exact gestational age of a newborn baby, especially premature baby, be determined to evaluate the status of a disease and its management and to estimate the prognosis of a patient. This study aimed to investigate an easy and accurate method to estimate gestational age on cranial ultrasound, requiring minimal additional time and equipment. Methods:A high-resolution coronal sonographic image was obtained via the anterior fontanel with a 5-12 Mhz linear probe after the usual cranial sonographic examination. We measured the depth of cerebral hemisphere, thickness of corpus callosum, and depth of cingulate sulcus and obtained the correlations between these factors and gestational age. Results:Depth of cingulate sulcus had the highest correlation coefficiency with gestational age (r=0.878, P=0.000). All the cases, except for 2 cases, had a gestational age of more than 37 weeks, when the depths of cingulate sulcus were more than 0.55 cm, and had a gestational age less than 34 weeks, when the depths of cingulate sulcus were less than 0.35 cm. Conclusion:Measurement of the depth of cingulate sulcus was a simple and accurate method to estimate the gestational age on cranial ultrasound. The gestational age is more than 37 weeks, when the depth of cingulate sulcus is more than 0.55 cm, and is less than 34 weeks, when the depth of cingulate sulcus is less than 0.35 cm.

=Abstract= Paradoxical response refers to the enlargement of old lesions or unexpected appearance of new lesions after initial improvement following treatment with antitubercular agents. Various types of paradoxical responses have been reported in the world, but they are rarely reported in Korean children. We report the case of a 17-year-old boy who was diagnosed with tuberculous pleurisy and was treated appropriately. Although the tuberculous pleurisy initially responded to medication with resolution of the pleural fluid, a new pulmonary lesion subsequently developed 3 weeks after the initiation of treatment that eventually cleared with continuation of the original drug regimen. (Korean J Pediatr 2009;52:717-720)

Burkholderia cepacia is a Gram-negative aerobic bacillus known to cause opportunistic infections in the immune-compromised hosts. This microorganism is strongly virulent and causes a necrotising invasive infection that may lead to death. As B. cepacia is highly resistant to various antimicrobials, combination antimicrobial therapy must be used instead of monotherapy. We report a successful treatment of lung abscess that was naturally caused by B. cepacia in a healthy child, through combination antimicrobial therapy of meropenem and trimethoprim/sulfamethoxazole and operative management.

Purpose: We wanted to assess the efficacy of using CT fluoroscopy during Fine Needle Aspiration (FNA) for focal lung lesion. Materials and Methods: We retrospectively reviewed 22 patients who had undergone FNA under CT fluoroscopic guidance. The final diagnosis of focal lung lesion was based on surgery, the results of biopsy taken from another site or the clinical diagnosis with imaging follow-up. We reviewed the imaging and recorded the location of the lesion, the lesion size and the depth from the puncture site. Results: In 24 cases of 22 patients, 16 lesions were benign and 8 were malignant. The sensitivity and specificity for malignant lesions were 100%, and 75%, respectively. The mean size of the malignant lesions was 3.751.68 cm, and that of the benign lesion was 3.052.98 cm. The mean depth of the lesion divided by the size was 1.85±1.09 for 20 lesions of the correct result group and 3.131.73 for 4 lesions of the incorrect result group; the difference between the two groups was statistically different (p=0.030). The complications after FNA were pneumothoraces in three cases and parenchymal hemorrhage in one case, but no significant complication was noted after the procedures. Conclusion: We could perform the FNA accurately and safely under CT fluoroscopy guidance, so this technique can be used for FNA of focal lung lesion for obtaining a correct result with fewer complications.

Wilson-Mikity Syndrome, a form of chronic lung disease, is rarely developed with the widespread use of mechanical ventilaton. There has always been difficulty distinguishing it from bronchopulmonary dysplasia. The etiology and pathogenesis of this disease are still unknown. There are no reports in Korean literature about high-resolution (HR) CT follow-up of this disease. Diffuse interstitial thickening, which was noted on the initial examination, decreased, but some focal hyperinflations remained on follow-up HRCT. Further studies with HRCT will help to understand the progression of the disease, and will help to develop treatment and management programs.