What is the Clinical Significance of Cerebrospinal Fluid Biomarkers in Parkinson's disease? Is the Significance Diagnostic or Prognostic?

The clinical diagnostic criteria of Parkinson's disease (PD) have limitations in detecting the disease at early stage and in differentiating heterogeneous clinical progression. The lack of reliable biomarker(s) for early diagnosis and prediction of prognosis is a major hurdle to achieve optimal clinical care of patients and efficient design of clinical trials for disease-modifying therapeutics. Numerous efforts to discover PD biomarkers in CSF were conducted. In this review, we describe the molecular pathogenesis of PD and discuss its implication to develop PD biomarkers in CSF. Next, we summarize the clinical utility of CSF biomarkers including alpha-synuclein for early and differential diagnosis, and prediction of PD progression. Given the heterogeneity in the clinical features of PD and none of the CSF biomarkers for an early diagnosis have been developed, research efforts to develop biomarkers to predict heterogeneous disease progression is on-going. Notably, a rapid cognitive decline followed by the development of dementia is a risk factor of poor prognosis in PD. In connection to this, CSF levels of Alzheimer's disease (AD) biomarkers have received considerable attention. However, we still need long-term longitudinal observational studies employing large cohorts to evaluate the clinical utility of CSF biomarkers reflecting Lewy body pathology and AD pathology in the brain. We believe that current research efforts including the Parkinson's Progression Markers Initiative will resolve the current needs of early diagnosis and/or prediction of disease progression using CSF biomarkers, and which will further accelerate the development of disease-modifying therapeutics and optimize the clinical management of PD patients.

Significance of Magnetic Resonance Imaging and Electroencephalography in Evaluating Children Visiting the Emergency Department with First Afebrile Seizures

PURPOSE: The purpose of our study is to evaluate the initial diagnostic value of magnetic resonance imaging (MRI) and electroencephalogrphy (EEG) in children who visit the emergency department (ED) with first afebrile seizure attacks. METHODS: We reviewed the medical records of children who visited the emergency department of Inha University Hospital with first afebrile seizure attacks and who underwent the diagnostic procedures of MRI & EEG during their visits. The study duration was for the 72 months from January 1997 to December 2002. One year after the study, we followed up the patients by using a telephone survey and by reviewing their medical records. RESULTS: The records of 46 patients, 23 boys and 23 girls, were reviewed. Generalized tonic clonic seizures appeared in 37 (80%) of the children and focal seizures in 9 (20%) of the children. Twenty nine (63%) of the children had two or more seizures during a single episode. There were 8 (17%) cases in which the seizures lasted for over 30 minutes. MRI abnormalities were found in only a small portion (9 cases, 20%) of the patients, but all of the MRI abnormalities were significant. The MRI abnormalities were as follows: brain atrophy (n=2), leptomeningeal enhancement (n=2), aneurysm (n=1), arachnoid cyst (n=1), ventriculomegaly (n=1), demyelinating disease (n=1), and hypoxic damage (n=1). Abnormal EEG findings were found in 15 (33%) of the children: Eleven showed partial seizures and 4 showed cerebral dysfunctions. CONCLUSION: Even though abnormal MRI & EEG findings were revealed in only a small portion of the patients, all of the revealed abnormal findings were very serious and were associated with significant problems. In conclusion, we suggest that initial MRI & EEG evaluations are valuable diagnostic procedures for children who visit the emergency department with first attacks of afebrile seizures.

Emergency Angiography in Evaluating the Open Fracture in the Emergency Department

PURPOSE: Our study aimes to examine the outcome of open fractures with associated vascular injury and to assess the diagnostic value of angiography in patients who visit the emergency department (ED). METHODS: The records of 22 patients who were diagnosed as open fracture in the ED of Inha University Hospital between June 1996 and December 2001 were selected for review. Angiography was done on the suspicion of vascularinjury for patients with abnormal vascular examination results and an unclear level of injury that might require vascular repair. RESULTS: There were 21 men and one woman with a mean age of 37 years. The injury resulted from traffic accidents in 59.2% of the patients. The femur and tibia were most commonly involved and the popliteal artery was too. 18 patients were confirmed vascular injury by angiography (81.8%). 14 abnormal angiographic findings were found in 15 (93.3%) of the patients who were predicted the vascular injury by clinical findings. 4 abnormal angiographic findings were found in 7 (57.1%) of the patients who were not predicted the vascular injury. The group of patients who had demonstrated vascular injury and repair was performed within 6 hours of injury showed lesser incidence of complication than 6 hours after injury. The overall amputation rate was 22.7% (5 of 22). CONCLUSION: The most important factor in successful management is early recognition and early repair of vascular injury in open fracture. In conclusion, we suggest that emergency angiography is valuable diagnostic procedures for patients who visit the emergency department with the open fracture.

Bone Mineral Density in Well Controlled IDDM / 대한소아내분비학회지

PURPOSE:Effects of IDDM on bone mineral metabolism are still in controversy. Some reported that bone mineral density in IDDM had inverse relationship with HbA1c, some reported that spine BMD was normal while femur BMD was decreased. Others reported that increased urinary calcium excretion in IDDM induced early trabecular bone mineral loss. We studied the correlation of BMD with diabetic control and body measurements. METHODS:In sixteen IDDM patients, using dual energy X-ray absorptiometry, BMD was measured in lumbar spine as trabecular bone and femur neck as cortical bone. Z-score of BMD was obtained by comparing age and sex matched control data. Correlations between BMD and diabetic control parameters (HbA1c, duration of IDDM) and body measurements were calculated. RESULTS:The body measurements were in normal range in all IDDM patients, the duration of IDDM was 38.4+/-24.0months, HbA1c was in good control state (7.69+/-1.53%), and urinary Ca/creatinine ratio was not increased. The Z-score of BMD was not decreased statistically (lumbar spine: -0.255, femur neck: -0.404), and the Z-score had no correlationship with body measurements and diabetic control parameters. CONCLUSIONS:In well controlled childhood IDDM, BMD was not decreased significantly.

Nonoperative Treatment of PDA Using the Duct-Occlud

PURPOSE: Among the several transcatheter devices of PDA occlusion, Rashikind device was the most extensively experienced, but it had risk of occluder embolism and incomplete occlusion of PDA, approximately 27%. The authors used Duct-Occlud , made of 0.028 inch stainless steel coil. The coil is double cone-shape in released state, and used in streched condition through 4F implantation catheter for ductus occlusion. We are to report the short-term result of PDA occlusion using Duct-Occlud. METHODS: Six patients with internal ductal diameter of less than 3.5mm were selected for ductus occlusion. The Duct-Occlud was selected as follows : the diameter of aortic end was same as aortic ampulla, and the length was slightly shorter than that of ductus. The streched coil was introduced into descending aorta through implantation catheter, and the remaining coil was released in ductus and pulmonary artery subsequently. Postprocedure aortic angiogram was obtained and echocardiography was performed at 1day, 1 week, 1 month and 3 month after the procedure. RESULTS: Except one hourglass type, all the other PDA were tunnel shaped. The range of internal diameter of ductus was 0.83-2.4mm, the length 5.36-P12.4mm, and Qp/Qs 1.04-1.67. Three cases required repositioniong of coils, while the others were successful in one procedure. The residual shunts were resolved at 1 day in most cases, but two cases in 1 month after the procedure. There were no complications, such as coil embolism, migration, or pulmonary stenosis. CONCLUSIONS: In small PDA with internal diameter of less than 3.5mm, transcatheter occlusion using Duct-Occlud is easy, safe and accurate, except with high cost.

Three Cases of Necrotizing Lymphadenitis in Childhood

No abstract available.