IL-1beta and IL-1RN polymorphisms in gastroduodenal diseases / 대한내과학회지

BACKGROUND: IL-1beta and IL-1 receptor antagonist (IL-1RN) genetic polymorphisms have been associated with development of gastric atrophy and increased risk of gastric carcinoma. This study aimed to determine the effects of these polymorphisms in gastroduodenal diseases. METHODS: This study population was comprised of 297 patients and they were grouped into gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. We determined IL-1beta-511/-31/+3954 and IL-1RN genotype by polymerase chain reaction using gastric biopsy specimens. RESULTS: The genotype of IL-1beta-511 C/T, -31 T/C, +3954 C/C, and IL-1RN *1/*1 was predominant in all four groups. Allelic and genotypic frequencies of IL-1beta-511/-31/+3954 and IL-1RN showed no significant difference in four groups. IL-1beta-511 T/T, -31 C/C, +3954 C/T, and IL-1RN *2 carriers did not show increased risk of gastric ulcer, duodenal ulcer and gastric cancer. Classification of gastric cancer into intestinal and diffuse type also showed no significant difference of IL-1beta-511/-31/+3954 and IL-1RN genotypic frequencies. CONCLSUION: There was no significant difference of IL-1beta and IL-1RN polymorphisms between patients with gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Therefore, other endogenous or exogenous factors will play more important role in the development of gastroduodenal diseases in Korean.

Clinical characteristics of nocturnal epilepsy

BACKGROUND AND OBJECTIVES: Nocturnal epilepsy is rare but an interesting phenomenon suggesting a close relationship between epilepsy and sleep. However, previous efforts to characterize the nocturnal epilepsy as a specific epileptic syndrome have been incomplete. This study was conducted to evaluate the prognosis and the recurrence rate of diurnal seizure in patients presented with nocturnal seizures only to further determine the clinical characteristics of nocturnal epilepsy. METHODS: Sixty-six patients with nocturnal seizures only were identified through the epilepsy registry form of the Yonsei Epilepsy Clinic(YEC) Data Bank. All patients had thorough history, physical and neurological examinations, blood tests, sleep deprived EEG with nasopharyngeal electrodes, and MRI or CT of brain according to the protocol of YEC. Patients followed at the YEC shorter than one year were excluded from the data analysis. All patients included to the study were initially treated by maximally tolerable monotherapy and then polytherapy if seizures were not controlled. RESULTS: Among sixty-six, patients, seizure descriptions were compatible with generalized tonic-clonic seizures in forty-seven patients and partial seizures with or without GTC in ninteen patients. EEG demonstrated either generalized or partial interictal epileptiform discharges in twenty-nine patients. CT or MRI showed focal lesions in eleven patients. For the follow up period of average thirty-nine months, twenty-five patients developed seizures while awake. Comparison of clinical characteristics between the patients with nocturnal seizures only and the patients with recurrent diurnal seizures did reveal followings ; duration of seizures at the time of initial evaluation was longer in the diurnal seizure (6. 7 vs. 9. 3 years), but it was not statistically significant (p<0.05). The presence of partial features in the history, neurological examinations, EEG, and MRI were more frequently associated with recurrent diurnal seizures. Responses to the AEDs.

Effects of Long-term Levodopa Treatment to Depression in Parkinson's Disease

Depression is frequently accompanied in idiopathic Parkinson's disease, and there were many researches about the pathogenetic mechanism of the depression. Recently the depression is thought to be developed by endogenous mechanism or reactive mechanism. To investigate the relationship between the changes of depression and the responsiveness of movement symptoms to the levodopa therapy, the UPDRS and BDI were checked before and after treatment of long-tem levodopa treatment. After levodopa treatment, the UPDRS was significantly improved but the depression was not improved. The depression severity in patients with Parkinson's disease were not influenced by the age, sex, symptom duration, treatment duration and the improvement of movement symptoms. And there were no differences in the clinical features between the levodopa responsive group and levodopa unresponsive group. Any clinical parameters do not predict the responsiveness of the depression to the levodopa therapy. These results suggest that the depression in Parkinson's disease, if it is endogenous, is related to neurochemical systems other than dopaminergic, or if it is reactive, is seldom influenced by drug-induced symptomatic improvement.

Characterization of the basal temporal language area

Basal temporal language area (BTLA), demonstrated by electric stimulation of the cortex in epilepsy patients rarely cause significant language problems after it resection. Recently, we experienced a patient who developed severe language deficits after the resection of BTLA. To characterize the language function of BTLA we compared the language characteristics in our patient with those of the previously reported characteristics of BTLA observed by either its resection or electrical stimulation. The BTLA was thought to play a major function in access to naming pool and in the comprehension partly through Wernicke's area. Also the visually associated language function, reading aloud and reading comprehension were known to be more damaged than visually unassociated function. Previous studies showed that BTLA identified by electrical stimulations in patients with epilepsy was usually found to be clinically insignificant for only minor and transient ]anguage deficits being noticed after its surgical resection with only rare exceptions. Our patient developed severe language deficits which lasted for at least several weeks after the resection of the epileptogenic lesion located in the BTLA. She had a calcified granuloma in inferior temporal gyrus and the WADA test in this patient revealed a strongly lateralized language and memory function to the resected temporal lobe. The precise neural mechanisms of severe language deficits found in this patient in unclear, however, our experience suggest that BTLA is involved in the language function to a significant degree at least in some patients. Further prospective investigations to preoperatively identify the patient group at risk of developing severe language deficits after the resection of BTLA are needed.

Characterization of the basal temporal language area

Basal temporal language area (BTLA), demonstrated by electric stimulation of the cortex in epilepsy patients rarely cause significant language problems after it resection. Recently, we experienced a patient who developed severe language deficits after the resection of BTLA. To characterize the language function of BTLA we compared the language characteristics in our patient with those of the previously reported characteristics of BTLA observed by either its resection or electrical stimulation. The BTLA was thought to play a major function in access to naming pool and in the comprehension partly through Wernicke's area. Also the visually associated language function, reading aloud and reading comprehension were known to be more damaged than visually unassociated function. Previous studies showed that BTLA identified by electrical stimulations in patients with epilepsy was usually found to be clinically insignificant for only minor and transient ]anguage deficits being noticed after its surgical resection with only rare exceptions. Our patient developed severe language deficits which lasted for at least several weeks after the resection of the epileptogenic lesion located in the BTLA. She had a calcified granuloma in inferior temporal gyrus and the WADA test in this patient revealed a strongly lateralized language and memory function to the resected temporal lobe. The precise neural mechanisms of severe language deficits found in this patient in unclear, however, our experience suggest that BTLA is involved in the language function to a significant degree at least in some patients. Further prospective investigations to preoperatively identify the patient group at risk of developing severe language deficits after the resection of BTLA are needed.

Experiences of epilepsy surgery in intractable seizures with past history of CNS infection

We studied the clinical characteristics, location of epileptogenic regions, and the surgical outcomes in 18 patients with intractable epilepsy associated with previous CNS infections. All patients underwent an extensive presurgical evaluation and 11 patients had intracranial EEG monitoring. On the basis of presurgical evaluation, epileptic regions were localized to the mesial temporal (n = 12) and the neocortical (n = 6) regions. The age of the time of CNS infection was significantly younger and the latent period of non-febrile seizures after CNS infection was longer in patients with mesial temporal lobe epilepsy (MTLE). MRI showed hippocampal atrophy and hippocampal signal changes in 11 of 12 patients with MTLE. Among 6 patients with neocortical epilepsy (NE) 5 patients had normal MRI and one showed cerebral hemi-atrophy. Surgery was successful (class I & II) in all patients with MTLE, however, in the patients with neocortical epilepsy, seizure-free results were not achieved in any patients after resective surgery (6 patients) and only 2 patients achieved Class II outcomes after a second epilepsy surgery consisting of neocortical resection. Patients with MTLE after CNS infection were differentiated from the group of neocortical epilepsy by an earlier onset of CNS infection, a prolonged latent period and a higher frequency of meningitis. The characteristic pathology in this group was hippocampal sclerosis and the surgical result was excellent. Neocortical epilepsy following CNS infection usually had no focal lesion on MRI and was associated with a relatively poor surgical result. This study suggested that the surgical outcome was influenced by the type of epileptic syndromes rather than the etiology of seizures. The association of MTLE with the younger age of CNS infections and with meningitis more frequently suggested that the neocortical neurons during infancy or early childhood may be more resistant to the epileptogenesis, or that the CNS infections in patients with MTLE might be milder in severity to cause selective injuries to the hippocampal neurons during their vulnerable stage.

The Clinical Factors Affecting Depression and its Frequency in Idiopath Parkinsonism

The purpose of this study was to investigate the frequency of depression and the relationships between various clinical features and depression in the patients with idiopathic parkinsonism. We included 113 patients of idiopathic parkinsonism who had any three of resting tremor, rigidity, bradykinesia, impaired postural reflexes or any one of the first three displaying asymmetry without definite brain lesion on brain imaging studies or metabolic derangement. We used Beck depression inventory, and the results were compared with those of 70 normal controls. The following results were obtained: 1.The patients with idiopathic parkinsonism had more severe depression than normal controls. If we@ consider the cut-point scores for depression as more than 21points of Beck depression inventory scores, the frequency of depression in idiopathic parkinsonism was 44. 1%. 2.The scores of the BDI questionare representing somatic symptoms were increased in the patient group, whether they had mild or severe parkinsonian deficits. The patients who had more severe parkinsonian deficits had higher scores. However, those representing mood and self-reproach symptoms were increased only in the late stage of idiopathic parkinsonism. 3.The severe motor symptoms, particularly bradykinesia and rigidity, poor responsiveness to L-dopa treatment, longer the duration of disease, were the factors correlated with severe depression. However the current age, age of onset, whether treated or untreated, and whether sy7rnptonis affected predominantly right or left side of the body, were not correlated with the severity of depression. On the basis of the results, when we regard no tremorous symption and the poor responsiveness to L-dopa treatment as the clinical features of idiopahtic parkinsonism, we suspect the tendency that the patients with idiopathic parkinsonism may have more severe depression than those with idiopathic P-qrkinson's disease.

Spontaneous Intracranial Hypotension: MRI findings

Spontaneous Intracranial Hypotension(SIH) is a rare syndrome of spontaneous postural cephalalgia associated with low CSF pressure and usually without evidence of CSF leakage from meningeal defect due to dural puncture. The postural headache may appear suddenly or gradually and disappear within several weeks spontaneously. MRI findings maybe include diffuse symmetric pachymeningeal gadolinium-enhancement, also subdural effusion and downward brain displacement. We report two cases of SIH in which MRI of the brain reveals diffuse symmetric pachyme-ningeal enhancement.

The Reference Values and Influencing Factors of TCD Measurements in 200 Normal Korean Adults

The clinical utility of transcranial doppler ultrasonography (TCD) in cerebrovascular disease has been extended recently. Although number of studies have been performed to define normal reference values of TCD measurements, they have some limitations to be used as reference values which include relatively small number of subjects, lack of data about some cerebral vessels and/or parameters. This study was aimed to obtain clinically useful reference values of TCD measurements with consideration of the influence of age and sex in Korean adults, particularly who are in stroke-prone age group. We measured flow velocities, pulsatility indecies, side-to-side differences and vasomotor reactivities of all intra-and extracranial cerebral arteries using TCD in 209 normal Korean adults (age, 23-78 years; 94 men and 115 women), and analyzed the influence of age and sex on those measurements. With advancing age, subjects showed significant reduction in velocity measurements and increase in pulsatility indecies of most examined arteries. Females showed hight velocities of middle cerebral, internal carotid, vertebral and basilar artery and lower pulsatility indecies of middle cerebral arteries compared with males. Asymmetry measurements including side-to-side differences and asymmetry index, and ,breath holding index testing vasomotor reactivity were also measured and the normal range of those parameters were calculated. Since present study included large number of subjects, and checked paramenters of TCD in both extra- as well as intracranial cerebral arteries, we are convinced that these results can be used as a reference data of TCD measurements in Korean adults.

Clobazam as An Add on Therapy in Patients with Complex

Clobazam is one of the benzodiazepine compounds consisting of different structure compared to previously marketed other benzodiazepines. In rescent days, the antiepileptic effects of this drug has been recognized and used in epileptic patients. To confirm the efficacy and side effects of clobazam, we review the records of the 60 patients who was medicated clobazam more than 9 months. These patients had complex partial seizure with unsatisfactory control despite of adequate drug dosage and duration. Among these patients, the improved one were 23 (38. 3%), and tolerant one were 25 with 5.6 month mean remission duration. Only the 7 of 60 patients complained the adverse symptoms and this were not serious enough to discontinue medication. In conclusion, clobazam is relatively safe and efficacious medication enough to try for patients with unsatisfactory seizure control.

A Study of Clinical Characteristics of Cryptococcal Meningitis: Diagnosis and Treatment in 38 cases

A clinical analysis was carried out in 38 patients with cryptococcal meningitis who were admitted at Severance hospital from January 1983 to June 1993. Age of patients ranged from 3 to 72 years (mean 37.5). The number of patients with underlying disease were 19(50%), which are equal to the number of patients without associated disease. The major presenting symptoms were headache in 36 patients (95%), fever in 26 patients(68%), nausea and vomiting in 20 patients(53%) in that order. The brain imaging findings were abnormal in 21 patients(57%). The antifungal therapy was done; amphotericin B only in 3 patients; amphotericin B and flucytocine in 23 patients; fluconazole only in 5 patients. The therapeutic responses were good in 19 patients(50%). The patients with favorable outcome were younger less having focal deficit, seizure, or associated disease.

Clinical Experience on Dural Sinus Thrombosis

Cerebral dural sinus thro-bosis(DST) has been described as a rare and severe disease, clinically characterized by headache, papiliedema, seizures, focal deficits,progressive coma and even to death With the, advances ih diagnostic tools particularly MRI, DST is more commonly detected and index of suspicion is being increased. In order to characterize clinical features of DST that has been rarely reported in this country, we investigate a series of 14 patients with radiologically cerebral dural sinus thrombosis. It showed a highly variable mode of onset, diverse causes and unpredictable clinical courses. DST consists of heterogenous disease entities, with more broad spectrum of clinical presentation. Outcome was felt to be rather favorable than previously thought. Therefore, early consideration of the possibility, proper neuroimaging diagnosis and appropriate therapeutic trial on individual basis is recommended in the management of DST.

Effect of premedicants , Diazepam and Atropine Sulfate an Human Inesulin Level in Plasma / 대한마취과학회지

This study was undertaken to investigate the effect of premedieants, diazepam and atropine sulfate in ten surgical patients by determining human plasma insulin. Also Insulin-Riakit was utilized as a kit for the detertrmination of insulin levels in the blood by radioimmunoassay (double antibody system). The plasma insulin level before administration of premedicants was 1:1. 1+/-1. 55 um/mL and 12. 6+/-2. 02um/ml. at 60 minutes after administration of premedicants so that the clinical significance of the results was absent. Sex ratio between male and female patients was 1: 1, mean age 39. 2+/-12. 1 and average body weight(kg) 55. 5+/-58.3. Consequently, there was no significant change in plasma insulin one hour after premedication and its result was within normal limits.