Tumor-like manifestation, uncommon form of multiple sclerosis: report of a patient.

Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system, characterised by focal neurological dysfunction with relapsing and remitting course. Acute widespread or tumor-like manifestation is one of the rare clinical variants and has poor prognosis. Here, the authors report a 36-year-old man who presented with left hemifacial and left hemibody anesthesia for one month. His symptoms gradually progressed MRI brain showed multiple large hypersignal intensity lesions in both right and left frontoparietal lobes, surrounding with brain edema. Brain biopsy showed perivenous infiltration of mature lymphocyte with demyelination. He was dramatically improved with high dose steroid. However, he later developed transverse myelitis syndrome. The second MRI showed new foci in both sides of splenium of corpus callosum and T9-10 spinal cord. The findings were compatible with an unusual form of multiple sclerosis that is rarely seen.

Serum lipoprotein (a) level and restenosis after percutaneous coronary intervention.

Restenosis is regarded as the result of a combination of various pathological events. The mechanisms are complex and not completely understood. In this study, the authors focused on the lipoprotein (a) (Lp (a)). It is one of the novel risk factors in atherosclerotic vascular disease. Numerous clinical studies suggest that individuals with elevated blood levels of Lp (a) have been shown to be associated with atherosclerotic vascular disease. However, whether a high serum concentration of Lp (a) affects restenosis after PCI remains controversial. In this study, the relationship between serum Lp (a) levels and restenosis after PCI was examined to investigate whether serum Lp (a) levels may be a predictor of restenosis after PCI. Of the 100 patients studied, 31 patients (31%) were classified as the restenosis group and 69 patients (69%) the non-restenosis group. Both groups did not significantly differ in serum concentration of total cholesterol, triglyceride, HDL-C, and LDL-C. The mean serum Lp (a) concentration in patients with restenosis was 41.50 +/- 34.99 mg/dL compared with a mean serum Lp (a) concentration of 29.87 +/- 25.47 mg/dL in those without restenosis. There was no statistical significance of Lp (a) level between the restenosis and non-restenosis groups (p=0.06). In healthy subjects, the normal reference range of serum Lp (a) concentration is below 30 mg/dL. From this reference, if a cut off point of serum Lp (a) concentration equal to 30 mg/dL or above to identify high Lp (a) level group was used. High serum Lp (a) level was established in 15 patients with restenosis versus 21 patients without restenosis. From this cut off point of serum Lp (a) level, the authors did not find a correlation between serum Lp (a) level and the restenosis group. (p=0.08).

Homocysteine and restenosis after percutaneous coronary intervention.

Numerous clinical studies in Western and Asian countries suggest that individuals with elevated blood levels of homocysteine have an increased risk of atherosclerosis, myocardial infarction, cerebral infarction, and deep vein thrombosis. Homocysteine is also known to induce both atherogenic and thrombogenic mediators in cultured vascular cells so that homocysteine may influence the damage of endothelial cells, promote smooth muscle cell growth, induce atherogenic mediators and thrombus formation after coronary angioplasty. The association between homocysteine and restenosis after percutaneous coronary intervention (PCI) has been discussed. In this study, the relationship between plasma homocysteine levels and restenosis after PCI to investigate whether plasma homocysteine levels may be a predictor of restenosis after PCI was examined. One hundred consecutive patients who underwent successful PCI were enrolled and plasma homocysteine level was measured in all patients prior to PCI. Plasma for homocysteine level was obtained in 99 of 100 patients who had angioplasty. The mean plasma homocysteine concentration in the enrolled patients was 13.61 +/- 6.04 micromol/L. The minimum and maximum of plasma homocysteine were 4.40 micromol/L and 50.00 micromol/L, respectively. In healthy subjects, the normal reference range of homocysteine level is 5-15 micromol/L However, recent data suggest that some patients may be at increased cardiovascular and cerebrovascular risk at levels as low as 12 micromol/L. For this reason, both cut off points of homocysteine level > or = 15 micromol/L or > or = 12 micromol/L to identify the high homocysteine level group were used. Of 99 patients, high homocysteine level (> or = 15 micromol/L) was established in 9 patients with restenosis versus 20 patients without restenosis. If the cut off point of homocysteine level > or = 12 micromol/L was used, high homocysteine level was established in 14 patients with restenosis versus 39 patients without restenosis. From both cut off points of homocysteine level, there was no correlation between plasma homocysteine level and the restenosis group. (p>0.05).

Spontaneous bacterial peritonitis, causes and antibiotic usage in Srinagarind hospital.

Spontaneous bacterial peritonitis (SBP) is a common and often fatal complication occurring in cirrhotic patients with ascites. It is defined as an infection of the ascitic fluid in the absence of any obvious intra-abdominal source. This study was a descriptive retrospective study that examined signs and symptoms of SBP, prevalence, result of the culture and antibiotic susceptibility of the organisms and outcome of antibiotic treatment, especially to ampicillin-aminoglycoside. Data were collected from inpatient medical records at Srinagarind Hospital between 1993 and 1997. Forty-four patients with 54 episodes of SBP were included in this study. The results revealed that SBP commonly occurred in cirrhotic patients. Presenting symptoms of SBP were fever, abdominal pain and abdominal distension, respectively. Signs of SBP were ascites and rebound abdominal tenderness. Forty-three per cent of ascitic fluid cultures were positive for bacteria E. coli (30.4%), Streptococcus spp (26.1%) and Klebsiella spp (13.0%) were the most common causes of SBP which were similar to other studies. Ampicillin plus an aminoglycoside were mostly often used in this study; in only 15.8 per cent of patients did the antibiotics need to be changed. Mortality rate in this group was not increased after antibiotic was changed.