Hydoroxocobalamin (Vitamin B12) Effects on Nerve Function Impairments in Leprosy / 나학회지

95 patients in Sorokdo national hospital injected 1-5mg Hydroxocobalamin (5mg/2ml/1ample) in 5-7 days/week, duration 6.4 months, average age 71.6 years old. Effects are 1) softening of hand movement(22/95), early effect, 2) improving of motor function (8/95) 3) sensory function(8/95) 4) sweating (3/95) 5) neuropathic pain and headache(neuralgia-like) (7/95) 6) jaw and hand tremor (7/95) 7) no response (41/95) 8) side effect (1/95) Leprosy is demyelinating peripheral neuropathy, Vitamin B12 effects on myelin, but unkown it's mechnism. Vitamin B12 improve nerve function impairments in leprosy, especially neuropathic pain and tremor, which lead to deformities and disabilities.

Pacemaker malfunction related to insulation break according to position change in a patient with complete AV block / 대한내과학회지

A 53 year-old woman presented with intermittent dizziness and palpitation. She had received VVI type pacemaker due to complete AV block in 1990, and exchanged by VVIR type pacemaker thirteen years later. 1 year later, she suffered intermittent dizziness and palpitation in erect position, not in supine position. Intermittent pacing failure and sensing failure was observed in pacemaker test, especially in erect position, not in supine position. Pacing threshold was increased in erect position, but lead impedance was not changed. Insulation break was observed in bipolar lead by fluoroscope. Initially we tried a new lead implantation by cephalic access to prevent lead related complication, but failed. So, we implanted a new bipolar lead by subclavian access. Finally, she was treated by a new bipolar lead implantation.

Pheochromocytoma in pregnancy: A case report / 대한내과학회지

Pheochromocytoma during pregnancy is very rarely discovered, and this condition is life threatening to both mother and fetus. Maternal and fetal survival depend a lot on an early diagnosis, a correct medical therapy and a correct timing of delivery and surgery. We describe a case of pheochromocytoma during pregnancy. A patient was transferred to our hospital during gestational week 24 with severe hypertension, generalized edema. Pheochromocytoma caused by a left adrenal mass was diagnosed. The patient was treated with titrated dose of phenoxybenzamine, propranolol, and intravenous nicardipine, but intermittent severe hypertension was developed. At 33 weeks gestation, fetal distress was developed, and emergent cesarean section was done. Two weeks after delivery, she underwent a successful left adrenalectomy. Two months after surgery, all antihypertensive medications were discontinued and her blood pressure have remained normal range.

Infected Pneumatocele Following Anaerobic Pneumonia in Adult

We report a case of an infected pneumatocele in the course of anaerobic pneumonia in an adult. To the best of our knowledge, anaerobic pneumonia complicated by a pneumatocele in an adult has not previously been described. The pneumatocele occurred on the fifth day of hospitalization, and rapidly increased in size, with the development of a subsequent mixed anaerobe infection. A pig-tail catheter was inserted and the pus drained. The bacterial culture from the pus was positive for three anaerobes: Bacteroid species, Peptostreptococcus asaccharolyticus and Fusobacterium species. Intravenous antibiotics and percutaneous catheter drainage resulted in a successful treatment.

A Study of Intermal Medical Disorder in a Psychiatric Inpatients

BACKGROUND: This study was designed to investigate the relationship between psychiatric disease and systemic Internal Medical disease in psychiatric inpatients who were consulted to department of Internal Medicine and was directed to assess the physical problems and possible ways to resolve them in a closed psychiatric unit. METHOD: Through evaluation of medical records of 1549 inpatients who had consulted in department of internal medicine in Seoul National(mental) Hospital from January 1, 2002 to December 31, 2002. We classified the Physical illness according to ICD-9-CM and psychiatric disease according to DSM-IV RESULTS: The results were as follows: 1) In age and sex distribution, male was 64.4% and 45.9% of the subject was 4th and 5th decades. 2) The most systemic diagnosis were disease of respiratory system, disease of digestive system and endocrine system. 3) schizophrenia showed the highest rate in respiratory disease. Rate of digestive disease was the highest in alcohol use disorder. Disease of respiratory system and disease of digestive system were the most frequent in mood disorder 4) In 1st decade, Digestive system digease was the most frequent, others were respiratory system disease. 5) onset age of psychiatric disease was the oldest in circulatory disease. In genitourinary system disease, duration of psychiatric disease was the longest CONCLUSION: The clinical characteristics of psychiatric disease influenced to get systemic disease in psychiatric patients.

A Study of Physical Disorder in a Geriatric Psychiatric Inpatients

BACKGROUND: This study was designed to investigate the relationship between psychiatric disease and systemic disease in geriatric psychiatric inpatients who were consulted to department of internal medicine and were above 6th decade, and was directed to assess the physical problems and possible ways to resolve them in a closed psychiatric unit. METHOD: Through evaluation of medical records of 225 inpatients who had consulted in department of internal medicine in Seoul National Mental Hospital from January 1, 1998 to December 31, 1999. We classified the physical illness according to ICD-9-CM and psychiatric disease according to NTA. RESULTS: The result were as follows: 1) In age sex distribution, male was 62.7%, and 81.8% of the subjects was 6th decade. 2) The most common systemic diagnosis were disease of circulatory system, disease of digestive system, and disease of respiratory system. 3) The most systemic disease was disease of circulatory system in 6th and 8th decade. 4) Disease of circulatory system in all psychiatric disease was the most frequent. 5) Rate of circulatory disorder was the highest in organic mental disorder. Disease of digestive system and disease of endocrine system were the most frequent in alcoholics. Disease of respiratory system showed the highest rate in schizophrenea. CONCLUSION: The clinical characteristics of psychiatric diseases influenced to get systemic disease in geriatric patients.

A Case of Postpoliomyelitis Muscular Atrophy

A relationship between preceding acute paralytic poliomyelitis and the later development of motor neuron disease has only occasionally been suggested since it was first postulated by Charcot in 1875. The authors recently experienced a 20-year-old male who was considered to have postpoliomyelitis muscular atrophy. We report this case in view of its rarity and necessity of differential diagnosis from other neuromuscular disorders. Clinical presentation included slowly progressive muscle wasting of left thigh for 4 years, mild weakness of left arm and both thigh, intermittent fasciculation, and previous history of acute paralytic poliomyelitis. Electromyographic findings showed fibrillation potentials, positive sharp waves, fasciculations, giant motor unit potentials and reduced interference patterns. Muscle biopsy revealed scattered small angulated fibers, individual myofiber degeneration and mild inflammatory cell infiltration.

A Study of Topography of Flash VEP in Patients with Cerebrovascular Disease

The author studied the diagnostic usefulness of topography of flash visual evoked potential (FVEP) in evaluation of the patients with cerebrovascular diseases (CVDs) proven by brain CT scans. The patient group of 21 cases were consist of 10 cerebral infarctions and 11 intracerebral hemorrhages, that occurred at various sittes; 2 frontal lesions, 8 temporopariental lesions, 2 occipital lesions, and 8 basal ganglia lesions. As a control group, topographic studies of FVEP were done in 25 patients with no clinical eviddences of central nervous system diorders and visual symptoms. Topographic studies of FVEP with 12 recording electrodes, using Topography system 700 (San-ei), were done by binocular flashlight stimulation at the rate of 2/sec with the eyes closed. Topographic studies of FVEP were evaluated visually and the asymmetry of topography was considered as abnormal. Three types of topography were used; spatial-temporal mapping up to 300 msec of latency, latency mapping of wave II and VII (Cigenek, 1961), and amplitude mapping of wave II and VII. In both control and patient group, FVEP recorded at O1 and O2 were also obtained. The results were as follows: 1. In control group, absolute latencies and amplitudes of wave II and VII were much variable in FVEP recorded at O1and O2. Interhemispheric differences of amplitudes of wave II and VII were also much variable, but those of latencies were the least variable parameters; 1.89+1.24 msec in wave II and 2.65+3.90 msec in wave VII. Interhemispheric differences of latencies and amplitudes in patient group were interpreted as normal within the mean value plus 2 standard deviation of those of control group. 2. In patient group, abnormal FVEP recorded at O1 and O2 were observed only in 11 cases, among which 8 cases (38%) were consistent in lateralization of supratentorial lesions on brain CT scans. 3. Spatial-temporal mapping of FVEP, even in control group, was variable at each latencies, showing shifting asymimetries sidde to side and only suggested the tendency of greater amplitudes in right hemisphere and sequential transition of evoked responses. 4. In patient group, 17 cases showed abnormal latency mapping of wave II an/or wave VII, among which 13 (62%) were consistent in lateralization of supratentorial lesions. This relatively high concordance rate to brain CT findings was thought to be resulted from low variability of interhemispheric differences of latencies, and also suggested that latency mapping is more reliable method than other 2 types of topography of FVEP. 5. Amplitude mapping of wave II and/or wave VII showed 38% (8 cases) of concordance rate to brain CT findings in lateralization of supratentorial lesion. In conclusion, it is thought that topography of FVEP is a useful diagnostic test in evaluation of CVDs, and is also suggested that topography of FVEP can be used in evaluation of various supratentorial cerebral lesions functionally without such sophisticated criteria as in conventional FVEP interpretation.