Reversible Burst-suppression Pattern of Acute Hyperammonemic Encephalopathy

Acute hyperammonemic encephalopathy is generally associated with severe liver disease, manifesting with neuropsychiatric symptoms including confusion, lethargy, seizure, coma, and even death. Electroencephalogram (EEG) is a proven diagnostic, prognostic, and therapeutic tool in patients with acute and chronic encephalopathies. EEG changes in acute hyperammonemic encephalopathy are associated with background slowing in theta to delta ranges, accompanied by presence of triphasic waves. We reported a patient with acute hyperammonemic encephalopathy showing an unusual burst-suppression pattern, which was reversible with proper treatment.

Evaluation of internal adaptation of dental adhesive restorations using micro-CT

OBJECTIVES: The internal adaptation of composite restorations with or without resin modified glass ionomer cement (RMGIC) was analyzed non-destructively using Microcomputed tomography (micro-CT). MATERIALS AND METHODS: Thirty intact human teeth were used. The specimens were divided into 3 groups. In the control group, the cavities were etched with 10% phosphoric acid for 15 sec. Composite resin was filled into the cavity without adhesive. In group 1, light cured glass ionomer cement (GIC, Fuji II LC, GC) was applied as a base. The cavities were then etched, bonded, light cured and filled with composites. In group 2, the cavities were then etched, bonded, light cured and filled with composites without base application. They were immersed in a 25% silver nitrate solution. Micro-CT was performed before and after mechanical loading. One-way ANOVA with Duncan analysis was used to compare the internal adaptation between the groups before or after loading. A paired t-test was used to compare internal adaptation before and after mechanical loading. All statistical inferences were made within the 95% confidence interval. RESULTS: The silver nitrate solution successfully penetrated into the dentinal tubules from the pulp spaces, and infiltrated into the gap between restoration and pulpal floor. Group 2 showed a lower adaptation than the control group and group 1 (p < 0.05). There was no significant difference between the control group and group 1. For all groups, there was a significant difference between before and after mechanical loading (p < 0.05). CONCLUSIONS: The internal adaptation before and after loading was better when composites were bonded to tooth using adhesive than composites based with RMGIC.

The Effectiveness of Physical Therapy for the Horizontal Canal Cupulolithiasis

BACKGROUND & OBJECTIVES: Recently many reports suggest the horizontal canal benign paroxysmal positional vertigo (h-BPPV) is not rare. However there have been few reports on physical therapy for horizontal canal cupulolithiasis, while horizontal canal canalithiasis has a relatively well defined and effective therapy. To evaluate the efficacy of different methods of treating horizontal canal cupulolithiasis, we conducted prospective study. METHODS: We enrolled 104 consecutive patients who were diagnosed with h-BPPV. During that period, patients with posterior canal BPPV numbered 112. Patients with h-BPPV were diagnosed when lateral head rotation in the supine position resulted in geotropic or apogeotropic bilateral horizontal nystagmus. In patients presenting with apogeotropic variant (n=40), following maneuvers was performed sequentially. First of all, we performed head shaking and applied vibrator to the mastoid bone to detach otolith from cupula. If they failed to detach otolith from cupula, we performed barbecue rotation and forced prolonged position (FPP). The treatment outcome was considered as responsive when, immediately after each physical therapy, nystagmus shifted from apogeotropic to geotropic or no nystagmus was elicited by provocation test and symptoms of positional vertigo abated. RESULTS: There were 27 women and 13 men from ages 30 to 80 (mean 55) years. The average duration of symptoms before intervention was 0 to 12 (mean 0.6) days. In 4 cases, symptoms resolved spontaneously after provocation test. Of the 36 patients treated with headshaking, 6 were responsive. Of the 30 patients treated with vibrator after failure of head shaking, only 1 were responsive. In the barbecue rotation, none obtained relief after barbecue rotation. Of the 9 patients treated with FPP after failure of the barbecue rotation, 4 were symptom free after FPP. Twenty five patients, including 5 non-responders with FPP, underwent no more rehabilitation maneuver. In most of cases (n=24), horizontal canal cupulolithiasis resolved spontaneously within a week. CONCLUSIONS: The direct effectiveness of physical therapy for horizontal canal cupulolithiasis is largely unsatisfactory. However, in many cases, horizontal canal cupulolithiasis resolved spontaneously in a few days.

Reliability of history taking in the diagnosis of benign paroxysmal positional vertigo

BACKGROUND AND OBJECTIVES: Patients with benign paroxysmal positional vertigo (BPPV) usually have typical history. They usually complain of vertigo that lasting a few seconds to a minute. It usually occurs in the morning after awaking and provoked by typical positional change such as head turning, sitting, and lying down. However, some patients may describe their vertigo in a rather atypical way, so there is no absolute reliability of a diagnosis based on history taking. To evaluate the reliability of a diagnosis based on history taking, we performed prospective studies. MATERIALS AND METHODS: We obtained structured history from all the patients with BPPV. Total of 408 patients were diagnosed as having BPPV. The diagnosis was based on typical findings of vertigo and nystagmus by Dix-Hallpike maneuver and head turning in supine position. RESULTS: Duration of vertigo was more than 10 minutes in 22% of patients. Position-precipitating factors were not spontaneously reported by 37%. 16% of patients complained non-spinning vertigo. 38% of patients could not tell the side to which the spell occurs. In 83 cases (20%), it was impossible to diagnose BPPV based upon a typical history. CONCLUSION: We conclude that non-paroxysmal, non-positional vertigo dose not rule out BPPV. The provocation test is mandatory in those complaining of dizziness regardless of history since BPPV can be quickly diagnosed by provocation test and easily treated.

Treatment outcome of two different methods of canalith repositioning maneuver

BACKGROUND AND OBJECTIVES: Canalith repositioning procedure described by Epley is an effective treatment of benign paroxysmal positional vertigo (BPPV) based on the theory of canalithiasis. Although there are many modifications of Epley's maneuver, they have much similarity and are usually composed of 4 steps. However there is considerable variation of pause at each position from 6 seconds to 4 minutes. The purpose of this study is to determine treatment outcome of short and long pause at each position. MATERIALS AND METHODS: This is a randomized prospective study of patients with posterior canal type BPPV. One hundred patients were randomized to one of two groups at their first clinic visit between March 1999 and September 2000. The diagnosis was based on typical findings of vertigo and nystagmus by Dix-Hallpike maneuver and head turning in supine position. The authors treated patients with two different methods of the canalith repositioning procedure. One group maintained each position until the nystagmus stopped. If no nystagmus was observed, the position was maintained for 5 to 10 seconds. The other group maintained each position for 3 minutes. We assessed treatment outcomes of two methods. RESULTS: We can not find the difference of a success rate between two groups. CONCLUSION: It takes less than one minute with rapid head position changing method, so this method is more feasible in out-patients clinics.

Cardiovascular risk factors in men with normal and overweight according to waist-to-height ratio

BACKGROUND: Abdominal obesity is a risk factor for morbidity and mortality associated with cardiovascular disease. It has been reported that metabolically obese is common even in normal weight individuals. In this study, we analysed characteristics of cardiovascular risk factors in normal and overweight men using waist- to -height ratio to find out whether it reflects such risks. METHOD: Study subjects were 510 men. (18.5or=0.5, Group 3; 25.0or=0.5. The prevalence, Odds ratio for cardiovascular risk factors were compared. RESULTS: In normal weight group, the prevalence of hypertension(P<0.01), high blood glucose(P<0.01), hypercholesterolemia (P<0.05), hypertrigtceridemia (P<0.01) was significantly higher in group 1 than group 2. In overweight group, the prevalence of hypercholesterolemia (P<0.01), low HDL(P<0.01) was significantly higher in group 4 than group 3. When compared odds ratio for each groups with reference to group 1, adjusted for age, smoking status and regular exercise, high blood glucose(4.48), hvpertrigtceridemia(5.91) in group 2,hyertension(3.54) ,hypertriglyceridemia (3.44) in group 3, hypertension(2.90), hypertriglyceridemia (3.81), low HDL(2.60) in group 4 were significantly higher. CONCLUSION: Waist-to-height ratio may be a useful method for early detection of abdominal obesity and it's related risk factors in normal and overweight individuals.

Dissection of the vertebrobasilar artery

In spite of relatively common references as differential diagnosis in the cases of vertebrobasilar ischemia or infartion, there are only a few reports about dissections of the vertebrobasilar artery(VBA) in Korea. We reviewed medical records and radiographic findings of the 10 patients diagnosed as having dissections of the VBA at Seoul National University Hospital and Seoul City Borame Hospitall since 1994. The 10 patients, all men ranging from 15 to 58 years, did not have the usual risk factors for stroke. In 6 cases, temporally related trauma or exercise was noted. There were also 2 cases of delayed neurologic manifestations from preceeding trauma, developed 74 days and about I year later respectively. Most subjects(9 cases) showed the ischemic symptoms of posterior circulations. Subarachnold hemorrhage was manifested in 2 cases. Magnetic resonance imaging(MRD, magnetic resonance angiography(MRA) and transfemoral cerebral angiography(TFCA) showed irregular narrowing of proximal vertebral artery(VA) with non-visualization of its distal part, thrombosed VA, intramural high signal intensity in VBA, double lumen appearance or fusiform aneurysm. Until now(mean follow up period; 15 months), them are no recurrences with anticoagulation or antiplatelet therapy in the cases of vertebrobasilar ischemia. Dissections of the VBA should be included in the differential diagnosis of vertebrobasilar ischemia or infarction, especially in the young population or in the subjects without common risk factors. The diagnosis can be made on the bases of clinical features and the characteristic findings of MRI, MRA and TFCA.

Subacute sclerosing panencephalitis presenting as young adult onset parkinsonism

Subacute sclerosing panencephalitis(SSPE) is a fatal chronic persistent encephalitis due to a sequela of measles virus infection. It is almost developed in childhood or school aged children. It's onset after the age of 20 is very rare. In addition, SSPE with prominent parkinsonian features is not common. We experienced a 26-year-old man with bradykinesia, slurred speech and gait disturbance for 1 month. He showed masked face, vertical and right horizontal conjugate gaze limitation, generalized hyperreflexia, rigidity, and myoclonic jerks. His gait was small-stepped festinatinog and propulsive with intermittent freeziong and ignition failure. He had a history of measles at his age of 13. Brain magnetic resonance images and all biochemistries including coper and ceruloplasmin level of serum were normla. Characteristic periodic synchronous discharges were noted on electroencephalogram. The antibody titer to measles virus was highly increased in serum and cerebrospinal fluid. Symptoms rapikly progressed to vegetative state and expired in 9.5 months after the initial symprom. Autopsy was performed. All parts of brain were moderately atrophied. In microscopic examination, diffuse glial and inflammatory changed with neuronal loss throughout the entire brain were noted. So we suggest that the possibility of SSPE may be considered as a cause of young adult onset parkinsonism.

Prevalence of antibodies against chlamydia pneumoniae among blood donors and patients with tests of blood chemistry and mycoplasma pneumoniae antibody / 감염

No abstract available.

A case of leiomyoma on urethrovaginal septum / 대한비뇨기과학회지

Leiomyoma is rare. Most of patients present with urinary tract infection, hematuria, dyspareunia, or complaint of mass. A case of leiomyoma on urethrovaginal septum in a 36 years old female was presented. The presenting symptom was a protruding mass at the anterior vaginal wall The mass was removed surgically and confirmed as a leiomyoma pathologically.

No-incision pubovaginal suspension for stress urinary incontinence: 15 cases / 대한비뇨기과학회지

Fifteen stress urinary incontinence patients were treated using the modified endoscopic suspension of the bladder neck that eliminates all incisions during the period from January 1990 to December 1990. The average operation time was 26 minutes and the mean days of urethral Foley catheter removal were 3.9 days operation. Two point three days were required to restore the normal voiding pattern. Of 15 patients treated. 1 failure occurred, for an overall success rate of 93%. There had been no significant complications. Therefore, no-incision pubovaginal suspension was simple and effective means treating stress urinary incontinence.

A Case of Emphysematous Pyelonephritis / 대한비뇨기과학회지

Emphysematous pyelonephritis is a rare complication of severe acute pyelonephritis and a suppurative infection of the renal parenchyma characterized by the production of gas by bacteria through fermentation. Emphysematous pyelonephritis occurs in patient with diabetes mellitus or urinary obstruction. We review the diagnosis and management of emphysematous pyelonephritis and report a case of emphysematous pyelonephritis developed in renal tuberculosis.

A Case of True Hermaphroditism with Testicular Torsion / 대한비뇨기과학회지

True hermaphroditism. in which both ovarian and testicular tissue are found in the same individual, is a rare disease. Recently the authors have seen a case of true hermaphroditism who had a testis on the right gonad and an ovotestis on the left gonad with a karyotype of 46 XX, and report this case here with a brief review of the literature.