Medical Treatment In Patients Research Articles

Emerging Concepts in Intramural Hematoma Imaging.

Intramural hematoma (IMH) is included in the spectrum of acute aortic syndrome and appears as an area of hyperattenuating crescentic thickening in the aortic wall that is best seen at nonenhanced computed tomography. IMH is historically believed to originate from ruptured vasa vasorum in the aortic media without an intimal tear, but there are reports of small intimomedial tears identified prospectively at imaging or found at surgery in some cases of IMH. These reports have blurred the distinction between aortic dissection and IMH and raise questions about what truly distinguishes the entities that compose acute aortic syndrome. The pathophysiology of these subgroups and the controversies surrounding their differentiation are discussed. The natural history of IMH is highly variable; it may resolve or progress to aneurysm, dissection, or rupture. The authors review various imaging prognostic factors that should be reported by the radiologist, including Stanford classification, maximum aortic diameter, maximum IMH thickness, focal contrast enhancement (including ulcerlike projection and intramural blood pool), and pleural or pericardial effusion. Medical (nonsurgical) versus surgical treatment strategies depend primarily on the Stanford classification, although more recent studies of Asian cohorts report success of initial medical treatment in patients with Stanford type A IMH, with timed (delayed) surgery for patients who develop complications. Understanding the imaging appearance and prognostic factors of IMH helps the radiologist and surgeon identify patients at greatest risk for complications to ensure appropriate treatment and improve patient outcomes. (©)RSNA, 2016.

Chronic thromboembolic pulmonary hypertension--a diagnostic and therapeutic update.

Chronic thromboembolic pulmonary hypertension (CTEPH), an important cause of severe pulmonary hypertension, is still underdiagnosed, mainly due to the insufficient use of V/Q scannning in patients with pulmonary hypertension. This article reviews the current diagnostic approach and discusses the therapeutic options in this particular form of pulmonary hypertension. Every patient with CTEPH should undergo an evaluation in a specialised centre with experience in pulmonary arterial endarteriectomy (PEA) as the potentially curative surgical technique. Partly unresolved questions regard the status of the recently described percutaneous transluminal pulmonary angioplasty and the best medical treatment in patients with inoperable or recurrent/persistent pulmonary hypertension after PEA.

Endovascular Treatment versus Best Medical Treatment in Patients with Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

Endovascular treatment has emerged as a minimally invasive technique for patients with acute ischemic stroke to achieve recanalization. Our aim was to determine the effects of endovascular treatment on clinical and safety outcomes compared with best medical treatment. Fifteen randomized trials that compared endovascular treatment with best medical treatment in patients with acute ischemic stroke met the inclusion criteria. We calculated pooled odds ratios and 95% CIs by using random-effects models. The primary end point was a favorable outcome defined by a modified Rankin Scale score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days postrandomization. Of the 2980 subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to endovascular treatment compared with best medical treatment (2949 subjects analyzed; odds ratio, 1.82; 95% CI, 1.38-2.40; P < .001). Excellent outcome (modified Rankin Scale score of 0 or 1) was also significantly greater among those randomized to endovascular treatment (2791 subjects analyzed; odds ratio, 1.77; 95% CI, 1.29-2.43, P < .001). Risk of symptomatic intracranial hemorrhage was similar between endovascular treatment and best medical treatment (2906 subjects analyzed; odds ratio, 1.19; 95% CI, 0.84-1.68; P = .34). Compared with best medical treatment, the odds of achieving a favorable outcome or excellent outcome at 3 months postrandomization are approximately 80% higher with endovascular treatment among patients with acute ischemic stroke.

The choice of medication for treatment of patients with chronic pelvic inflammatory diseases

Patients with chronic pelvic inflammatory diseases are often exceeding 2/3 among women seeking for the obstetrician-gynecologist help. To determine the therapeutic strategy it is need clear ideas about the most common cause of pelvic inflammatory diseases and methods of their treatment. In practice, the most frequently are chlamydia and mycoplasma infection, gonorrhea rate is gradually reduced. Among the antibacterial agents with a wide spectrum of activity macrolides are the most popular in the treatment of uncomplicated forms of pelvic inflammatory diseases. Among them azithromycin has the best bio-availability, high efficiency and the possibility for pulse therapy. On the Ukrainian pharmaceutical market represented more than 20 azithromycin drugs. Hemomycin is the only azithromycin generic drug in Ukraine with establishing bioequivalence. The comparative study of hemomycin efficiency (main group) and other generic azithromycin medications registered in Ukraine (comparison group) in the treatment of 124 patients with chronic salpingoophoritis and cervicitis of chlamydial etiology was performed. After treatment in women of the main group there was almost complete reduction of clinical symptoms. In the comparison group positive dynamics was significantly less pronounced. In the main group the efficiency of chlamydial infection treatment was 100%, while in the comparison group 16.1% of cases marked failure. Restoration of normal vaginal biotope was reported in 95.6% of patients in the main group and in the comparison group in 23.2% of patients remained cocci flora. Hemomycin is superior in their effectiveness comparatively to other generic azithromycin drugs with pulse therapy regimen application. The appointment of hemomycin provides complete elimination of chlamydial infection, the completion of the inflammatory tissue response, vaginal flora restoration and protective properties of cervical mucous. According to the pharmacoeconomic qualities and clinical efficiency hemomycin is the drug of choice for antibacterial therapy of genital chlamydiosis.

168 Effects of Mirtazapine Combined With Standard Medical Treatment in Patients With Functional Dyspepsia Accompanying Psychological Distress: A Randomized, Double-Blind, Placebo-Controlled Trial

168 Effects of Mirtazapine Combined With Standard Medical Treatment in Patients With Functional Dyspepsia Accompanying Psychological Distress: A Randomized, Double-Blind, Placebo-Controlled Trial

Trial Level Analysis of Prostate-Specific Antigen-Related Versus Unrelated Endpoints in Phase III Trials of First-Line and Second-Line Medical Treatments of Patients With Metastatic Castration-Resistant Prostate Cancer

BackgroundNo endpoint (EP) has yet been recognized as a surrogate of overall survival (OS) after systemic treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of the present report was to suggest, using a trial-level analysis, what might be the most appropriate EPs for trials of new drugs for patients with mCRPC. Materials and MethodsA literature search of randomized trials of medical treatments in patients with mCRPC was undertaken. The response-related and time-to-event EPs were evaluated. For each trial, the differences in OS and the examined EPs between the experimental and control arms and a correlation coefficient for every relationship were calculated. An additional regression analysis was performed to determine the proportion of variability explained (R2trial) on OS for the most frequently reported EPs in the selected trials. ResultsA total of 28 studies were included in the present analysis. Correlation analyses documented a significant relationship between the prostate-specific antigen (PSA)-related response rate and OS. Although not significant, a strong correlation coefficient was found for the relationship of radiologic progression-free survival (PFS) and OS and of PSA-related PFS and OS. The strength of the relationships with OS for all 3 EPs was greater among the trials published from 2005 to 2014. ConclusionThe PSA response rate and radiologic PFS reported greater rates of correlation with OS among trials of medical treatments of mCRPC, in particular, in studies published in the past 10 years. Both PSA and PFS should be evaluated for surrogacy at an individual level in large prospective trials of medical treatments for patients with mCRPC.

Carotid artery disease progression and related neurologic events after carotid endarterectomy

During the last decade, there has been a dramatic improvement in best medical treatment for patients with vascular disease. Yet, there is a paucity of contemporary long-term data for restenosis and contralateral internal carotid artery (ICA) progression. This study assessed ipsilateral and contralateral disease progression and cerebrovascular events after carotid endarterectomy (CEA). A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. End points were restenosis ≥50% and ≥70%, contralateral carotid disease progression (50%-69%, 70%-99%, or occlusion) and stroke. Survival analysis and Cox regression models were used to assess the effect of baseline predictors. During the 11-year study period, 1639 patients underwent 1782 CEAs (50.0% patch closure, 23.9% primary closure, 26.1% eversion, and 2.5% combined with coronary artery bypass grafting). The combined stroke/death rate was 2.6% overall and 1.8% in the asymptomatic cohort. The rate of restenosis ≥50% at 2, 5, and 10years was 8.5%, 15.6%, 27.2%, and the rate for restenosis ≥70% was 3.4%, 6.5%, 10.2%, respectively. Restenosis ≥50% was predicted by hypertension (hazard ratio [HR], 2.09; P= .027), female gender (HR, 1.43; P= .042), and younger age (≤65years; HR, 1.56; P= .016), but not by statins, surgical technique, symptoms, or other baseline risk factors. Restenoses remained asymptomatic in 125 of 148 (84.5%). Progression of contralateral ICA disease at 2, 5, and 10years was estimated at 5.4%, 15.5%, and 46.8%, respectively. Contralateral progression was only predicted by smoking (HR, 1.74; P=.008). The stroke rate in patients with disease progression of the contralateral ICA was not different compared with those without progression (7.0% vs 3.3%; P= .063). Any-stroke rates at 2, 5, and 10years were 4.6%, 7.3%, and 15.7%, respectively. Predictors were symptomatic lesion (HR, 1.48; P= .039), renal insufficiency, defined as a glomerular filtration rate (GFR) of 30 to 59 vs<30mL/min/1.73m2 (HR, 0.34; P= .009) or GFR ≥60 vs GFR<30mL/min/1.73m2 (HR, 0.55; P= .109), and statin use (HR, 0.59; P= .006). Restenosis or contralateral disease progression after CEA, to a level that might warrant consideration for treatment, is very low. The potentially associated stroke rates are also very low and not clearly related to disease progression. With the exception of the postoperative duplex, surveillance within short intervals of<1 or 2years cannot be justified.

Vulnerable characteristics and interest in wellness programs among head and neck cancer caregivers.

Head and neck cancer (HNC) caregivers have poorer psychological health compared to patients and the general population but have not yet been targeted for wellness programs to reduce adverse psychosocial or physical health outcomes. To inform development of such programs, we identified potential vulnerabilities to poor outcomes and examined wellness program preferences among HNC caregivers. We also examined whether interest in wellness programs varied by potential vulnerabilities among HNC caregivers. Surveys were administered to caregivers (n=33) of HNC patients undergoing major surgery. Sociodemographic factors, caregiving characteristics, psychosocial functioning, and health behavior data were collected. Fisher's exact tests and t tests were used to examine characteristics associated with interest in the different types of wellness programs. Many caregivers reported a heavy caregiving load (88% live with patient and 73% provide daily care), a smoking history (42%), and compromised psychosocial functioning (45% with depressive symptoms and 33% with anxiety above population norms). Most caregivers were interested in wellness programs focused on diet/exercise (71.9%); cancer education (66.7%); stress reduction (63.6%); and finances, caregiving, and well-being (57.6%). Caregivers endorsed highest interest in programs offered during the patient's medical treatment (63.6%), and mail was the preferred program format (50.0%). Those with more depressive symptoms reported more interest in programs focused on cancer education (p=0.03); stress reduction (p=0.05); and educational classes on finances, caregiving, and well-being (p=0.01). Wellness programs offering a menu of options should be developed for HNC caregivers.

Pneumologie und Sport: Ein ambulantes Ausdauertraining mit sportmedizinischer Anleitung als effektive nicht-medikamentöse Therapiemaßnahme in der Pneumologie – eine Projektstudie

In the process of medical rehabilitation muscular endurance training is the main focus. Unfortunately, outpatient rehabilitation opportunities are limited and specialized pulmonary exercise groups ("lung sport groups") rarely available. Therefore we developed an outpatient endurance sports program for patients with respiratory diseases and evaluated its effectiveness. In this feasibility study 31 patients (50 ± 15 years) with diverse respiratory diseases were included. By professional functional exercise testing (incl. CPET and lactate measurement according to the standards of DGP and DGSP) the patients optimal training zone was determined and an individualized 12 week lasting aerobic endurance training with ≥ 3 sessions of 20 - 60 min/week realized. After completion of the exercise training program a significant improvement in dyspnoea (Borg-Scale: 65.7 ± 12.2 vs. 62.2 ± 12.6, p = 0.013), body constitution (BMI: 25.7 ± 3.3 vs. 24.3 ± 3.2 kg/m(2), p = 0.018; portion of body fat: 24.8 ± 5.8 vs. 23.8 ± 6.4 %, p = 0.043) as well as physical capacity (VO2 at 4 mmol/l Laktat: 24.2 ± 6.9 vs. 26.5 ± 7.6 ml/min/kg, p < 0.01; performance at 4 mmol/l Laktat: running/walking (n = 14) + 1.1 km/h, p = 0.018 and biking/bicycle ergometer (n = 17) + 8.7 Watt, p = 0.019) was recorded. These positive developments were also observed in mental and physical quality of life (quality of life questionnaire SF-36: physical score + 9.7 points, mental score + 4.5 points). The evaluated exercise program can easily be trained by the patient in a self-dependent setting and was seen to be an effective sports medical treatment in patients with diverse pulmonary diseases.

ANALYSIS OF SURVIVAL AND CHANGES IN CLINICAL STATUS OF PATIENTS WITH CORONARY ARTERY DISEASE AFTER ENDOVASCULAR RECANALIZATION OF CHRONIC OCCLUSION OF THE RIGHT CORONARY ARTERY

Background: Procedures performed in chronic coronary artery occlusion comprise from 10 to 20% of all transcutaneous coronary interventions, and their efficacy can amount to 90%. Despite this, their appropriateness for this type of disease is still a matter of debate. Aim: To assess efficacy and safety of interventions compared to medical treatment in patients with isolated chronic occlusion of the right coronary artery. Materials and methods: We analyzed results of treatment of 72 patients. From these, endovascular recanalization of chronic occlusion of the right coronary artery was performed in 39 patients (group 1), the rest 33 patients received medical treatment only (group 2). Clinical state parameters and adverse event rate were assessed during a follow-up of 12 months. Results: After 1 year, a notable reduction of functional grade (FG) of exertional angina was seen in the group 1. The number of patients with FG I increased from 3 (7.7%) to 20 (51.3%), р 0.05 at both time points). At 1 year, 94.9% (95% CI: 88,2–99,9%) of patients from the group 1 and 100% of patient in the group 2 were free of adverse clinical events. Conclusion: Transcutaneous coronary angioplasty for chronic occlusion of the right coronary artery significantly improves clinical course of ischemic heart disease at 2 and 12 months, compared to medical treatment, by decreasing FG of exertional angina. From clinical point of view, adverse events reported in the group of endovascular recanalization for chronic occlusion of the right coronary artery are insignificant.

Are Hospitalizations for Percutaneous Coronary Procedures Missed Opportunities for Teaching Rules of Secondary Prevention?

Percutaneous coronary intervention (PCI) is the most frequently used revascularization approach, often repeatedly applied. The quest for the ultimate revascularization procedure however may capture cardiologist's attention and lead them to minimize the issue of secondary prevention in their patients. Aims of this study were to assess: 1. The individual risk factor profile, 2. The relation between the risk factors correction and the number of hospital admissions for elective procedures, 3. The appropriateness of medical treatment in patients admitted for elective coronary invasive procedures (diagnostic and interventional). 4. The patients knowledge of threshold values for cardiovascular risk factors. 100 patients (71% males, mean age 68 years) consecutively admitted for elective coronary angiography or PCI. They underwent a classical risk factors assessment and were divided in three groups according to the number of admissions for coronary angiography and in two groups according to the number of PCIs. Fifty-seven% of patients had been previously admitted for invasive examination at least three times and 58% had already been treated with at least one PCI. Seventy-one% were treated with beta-blockers but only 25% of them received a dosage found effective in RCTs (randomized clinical trials). Sixty% were treated with ACE-inhibitors and 83% received the dosage found effective in RCTs. Fifty-two% were treated with statins and 95% received a dosage found effective in RCTs. Nine% were still active smokers. Fourty-nine% had a LDL cholesterol level above 100 mg/dL. The percentage of patients not on target was unrelated to the number of hospital admissions for invasive procedures. Modern cardiology is quickly embracing high tech procedures and trials results but often fails to spend enough time teaching how to control risk factors according to the recommendations of the evidence-based guidelines, even independently of the number of hospitalizations for invasive cardiovascular procedures.

Assessment of Gastric Emptying in Patients with Autoimmune Gastritis.

Symptoms of patients with autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric emptying. This study aims to investigate whether any delay in gastric emptying of solid food exists in patients with autoimmune gastritis and, if so, to identify the factors that might affect delayed gastric emptying. A total of 165 patients (106 women) diagnosed as having autoimmune gastritis were analyzed by means of a gastric emptying test. All patients underwent a standardized scintigraphic gastric emptying study. Patients with delayed gastric emptying and normal gastric emptying tests were then compared by means of factors that might affect gastric emptying. Also 65 patients with functional dyspepsia who had a gastric emptying study constituted the control group. The median gastric emptying T ½ time was 127.43min (min-max 50-953) for patients with AIG and 81min (min-max 21-121.6) for functional dyspepsia patients (p<0.001), and median percent retention at 2h was 63.8 versus 20.2 (p<0.001). In multivariate analysis, parameters that affected gastric emptying T ½ time were found as serum gastrin level (OR 1.002, 95% CI 1.001-1.004, p<0.001, chronic inflammation (OR 3.689, 95% CI 1.44-9.39, p<0.001), and increase in the degree of the atrophy of the gastric mucosa (OR 8.96, 95% CI 2.98-26.93, p<0.001). In patients with autoimmune gastritis, gastric emptying is generally delayed. Autoimmune gastritis is an important etiology to explain the finding of delayed gastric emptying on a radionuclide test. This new finding is likely to be relevant to clinicians when evaluating and initiating appropriate medical treatment for patients with autoimmune gastritis manifesting upper gastrointestinal symptoms.

SAT-369 - Medical Treatments in Patients with Primary Sclerosing Cholangitis Differ between Europe and North America

SAT-369 - Medical Treatments in Patients with Primary Sclerosing Cholangitis Differ between Europe and North America

Hemorrhagic stroke and oral anticoagulants: What is to be done?

Hemorrhagic stroke (HS) is associated with high mortality and disability rates. Due to the introduction of the current guidelines for the prevention of systemic thromboembolic events in patients with atrial fibrillations and to an increase in the number of older patients, there has been a rise in the incidence of intracranial hemorrhage (ICH) associated with the use of oral anticoagulants. The paper discusses medical treatment in patients with HS during therapy with vitamin K antagonists (warfarin) and novel oral anticoagulants (dabigatran. rivaroxaban, apixaban), as well as an anticoagulant resumption policy after prior ICH in patients at high risk for thromboembolic events.

Efficacy of medical therapy in patients with trigeminal neuralgia attending Lagos University Teaching Hospital, Lagos, Nigeria

Background: Trigeminal neuralgia is characterized by brief episodes of sharp, shock-like, unilateral pain in the area of distribution of the Trigeminal nerve. Objective: This study seeks to assess the efficacy of medical treatment of patients suffering from Trigeminal neuralgia. Methods: A preliminary descriptive study of patients with Trigeminal neuralgia attending the Oral Medicine clinic of a tertiary institution in western Africa, using information from their case notes. Results: A total of 16 patients with Trigeminal neuralgia were assessed. 9 (56.3%) were females, 7 (43.8%) were males with age range of 29-80 years. All the patients presented with sharp, shock-like pain with sudden onset. With the institution of medical therapy, there was reduction of pain in 85% of patients within 6 months of therapy, while 4 (30.8%) were completely pain free after institution of therapy. Recurrence of the condition occurred in 8 cases, with 2 of the patients presenting with periods of complete remission of pain for a period of 3-4 months before recurrence. None of the patients have had the option of surgical intervention as an alternative to medical treatment since the response to medical treatment was good in majority of cases. Conclusion: There is no definite cure for this condition, therefore the ability to control pain to improve the quality of life of patients is of importance. Medical therapy (either monotherapy or multi-drug therapy) has been shown to be an effective treatment modality in managing this debilitating condition. Keywords: Trigeminal neuralgia, pain, medical therapy

Оптимизация медикаментозного лечения пациентов с острым бактериальным риносинуситом

Оптимизация медикаментозного лечения пациентов с острым бактериальным риносинуситом

Issues Related to the Updated 2014 Korean Guidelines for Tuberculosis.

Tuberculosis (TB) remains a major public health problem in South Korea. The Joint Committee for the Development of Korean Guidelines for Tuberculosis published the Korean Guidelines for Tuberculosis in 2011 to provide evidence-based practical recommendations to health care workers caring for patients with TB in South Korea. After reviewing recent national and international scientific data on TB, the committee updated the Korean guidelines for TB in 2014. This article presents some practical issues related to the 2014 updated guidelines: namely use of the Mycobacterium tuberculosis - polymerase chain reaction assay and the Xpert MTB/RIF assay in the diagnosis of TB, as well as medical treatment for patients with multidrug-resistant TB.

Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis

Primary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first-line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments. Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). Although topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops. We included randomized controlled trials (RCTs) that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE, and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses. We included 114 RCTs with data from 20 275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in millimeters of mercury at 3 months ordered from the most to least effective drugs were as follows: bimatoprost 5.61 (4.94; 6.29), latanoprost 4.85 (4.24; 5.46), travoprost 4.83 (4.12; 5.54), levobunolol 4.51 (3.85; 5.24), tafluprost 4.37 (2.94; 5.83), timolol 3.70 (3.16; 4.24), brimonidine 3.59 (2.89; 4.29), carteolol 3.44 (2.42; 4.46), levobetaxolol 2.56 (1.52; 3.62), apraclonidine 2.52 (0.94; 4.11), dorzolamide 2.49 (1.85; 3.13), brinzolamide 2.42 (1.62; 3.23), betaxolol 2.24 (1.59; 2.88), and unoprostone 1.91 (1.15; 2.67). All active first-line drugs are effective compared with placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost, should be considered in selecting a drug for a given patient.

MitraClip and Transcatheter Aortic Valve Implantation (TAVI): State of the Art 2015

The feasibility, safety, and efficacy of transcatheter heart valve (THV) therapies such as MitraClip and transcatheter aortic valve implantation (TAVI) have made them valid therapeutic options in high-risk or inoperable patients with heart failure (HF). Randomized controlled trials (RCTs) demonstrated noninferiority and superiority in terms of efficacy for 12 months of TAVI versus surgical replacement and optimal medical therapy, respectively. With regard to MitraClip, noninferiority was first demonstrated in four subgroups at 12 months and then later at 4-year follow-up. This difference in clinical outcomes between the two therapies is consistent with the discrepancy in the level of recommendation and class of evidence for TAVI and MitraClip according to recent international guidelines (IB vs. IIbC, respectively). Data from ongoing RCTs and national registries will help establish the reciprocal role and hierarchy among THV therapies, surgery, and medical treatment in patients with HF.

Patients with idiopathic normal pressure hydrocephalus improved executive dysfunction after shunt operation

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by cognitive decline, gait disturbance and impairment in bladder control. We evaluate changes in cognitive function before and after medical treatment for patients with iNPH. Objective: To report the changes of frontal dysfunctions. Patients and methods: We have diagnosed clinical inspection using Japanese NPH Grading Scale-revised to them. First of all, patients took mini-mental state test (MMSE) for memory decline, then took frontal assessment battery (FAB) and Behavioural Assessment of the Dysexecutive Syndrome (BADS). Only the cases that improved by tap tests were performed lumboperioneal (LP) shunt operations. We examined neuropsychological tests once before tap test and same tests in a half year after surgery. Results: Twenty six patients with iNPH were operated. Significant improvement between before and after operation was found in profile scores of FAB (9.6 ± 3.0 to 11.2 ± 2.9) and BADS (7.6 ± 3.8 to 9.6 ± 3.8). At the Conflicting Instructions and Go/No-Go of FAB item showed significant improvement after the operation. And the categorized item of Action Program in BADS was also improved, although no changeable of MMSE score. Conclusion: It was controversial that the executive dysfunction was recovered by LP shunted taking FAB and BADS. The executive dysfunction is related to the prefrontal area. Especially, Go/No-Go and Conflicting Instructions item showed activity in the posterior part of the inferior frontal sulcus. Memory disturbance is not the main affected impairment by iNPH. We think that the obstacle in iNPH is related with frontal lobe functions such as the executive dysfunction.