Predialysis Urea Nitrogen Is a Nutritional Marker of Hemodialysis Patients / 전남의대학술지

End-stage renal disease (ESRD) patients on hemodialysis have poor nutritional status and associated problems such as inflammation and sarcopenia. Blood urea nitrogen (BUN) is an important measure of uremic toxins, and urea reduction is a marker of hemodialysis efficacy. However, a low protein diet for lower BUN could aggravate malnutrition in patients, and optimal pre-dialysis BUN is not defined. We investigated the association of pre-dialysis BUN with patients’ comorbidities and the relationship between pre-dialysis BUN and serum albumin as a nutrient marker. Among the 67 patients, the average pre- and post-dialysis BUN were 59.2 and 15.0 mg/dL, respectively, serum creatinine was 10.1 mg/dL, and the average serum albumin was 4.0 g/dL. Patients’ age was negatively correlated with serum creatinine (r=−0.277, p<0.05) and albumin (r=−0.453, p<0.001). Predialysis BUN showed a significant positive correlation with serum albumin (r=0.287, p<0.05) and creatinine (r=0.454, p<0.001). However, the predialysis BUN was not significantly related to diabetes, coronary artery disease, congestive heart failure, or cerebrovascular disease. Hemodialysis patients with high pre-dialysis BUN and high serum creatinine could be regarded as having good nutritional status. The significance of this study lies in the potential utility of pre-dialysis blood urea nitrogen as an indicator of the nutritional status of patients. Liberal protein intake might be recommended to adequately dialyzed patients.

A Case of Unexpected Cotton Swap Foreign Body in the Ear Canal Causing Otogenic Skull Base Osteomyelitis / 대한이비인후과학회지

Otogenic skull base osteomyelitis (SBO) is a rare but life threatening disease, usually originating from a preceeding infection of the ear canal. It occurs dominantly in the elderly with diabetes or immunocompromised patients. However, foreign bodies in the ear canal may be a contributory factors causing otogenic SBO in healthy subjects. We describe a case of a previously healthy 51-year-old man, who was diagnoised with otogenic SBO after a physical exam and MRI scan. The patient complained of progressive otalgia lasting for one year and facial palsy that occurred three days before the visit. During the hospital course, an unexpected cotton swab was found in the ear canal. This was highly suspected as the main cause of otogenic SBO because, in the course of careful history taking, the patient remembered clearly that the cotton part of a cotton swab broke off in his ear a year ago. This case suggests that attention should be paid to high index suspicious foreign bodies in healthy subjects who are diagnosed with otogenic SBO, and extensive history taking and physical exam should be directed to this area.

A Case of Tetramine Intoxication from the Neptunea

Seafood is a vehicle for the transmission of intoxication. The Neptunea are sublittoral species of the marine prosobranch mollusk. Tetramine toxin is found in the salivary gland of Neuptunea. A woman developed blurred vision, dizziness, headache, diarrhea, numbness and gait disturbance one hour after ingesting conchs. Neurological examination showed dysesthesia, and motor weakness. Laboratory and electrophysiological studies were normal. The next day, she recovered from her symptoms. We report a patient with dysesthesia and motor weakness due to Neuptunea species' tetramine toxin.

A Case of Vogt-Koyanagi-Harada syndrome presenting initially with recurrent vertigo

Besides meningism, dizziness has also been frequently reported as a neurologic manifestation of Vogt- Koyanagi-Harada(VKH) syndrome. These neurotologic symptoms usually develop just before or after ocular involvement. We report the patient with VKH syndrome who showed recurrent peripheral vertigo. The characteristic opthalmological symptoms developed later in this case.

A Case of Hemiageusia Associated with Pontine Infarction

The generally accepted taste pathway in an animal projects ipsilaterally from the solitary nucleus. However, the path-way of gustatory fibers in the human brainstem has not been sufficiently clarified. A 57-year-old hypertensive man was admitted with sudden dizziness and hemiageusia. A neurological examination revealed also a diminution of taste on the left half of his tongue. A MRI showed a high signal intensity in the right lower pontine area. This case suggests that the unilateral lesion of the pons may lead to contralateral taste disturbances.

A Case of Hypoglycemic Hemiplegia: Reversible Change of Diffusion- and Perfusion-Weighted MRI

Hypoglycemic hemiplegia is an under-recognized manifestation of hypoglycemia and mimics cerebrovascular dis-ease, especially in elderly patients. We report a 70-year-old diabetic woman with hypoglycemic hemiplegia, whose dif-fusion- and perfusion- weighted images showed large cortical high signal intensities and hypoperfusion of the right hemisphere during the period of hypoglycemia. We suggest that the regional cerebral blood redistribution and selective vulnerability in hypoglycemia are responsible for the laterality of neurological deficits observed during hypoglycemic episodes.

Malignant Proliferating Trichilemmal Tumor Showing Invasion into the Brain Parenchyme

A 32-year-old man was admitted to our hospital due to a headache. A brain CT and MRI showed a parenchymal mass in the right temporoparietooccipital lobe and histopathological specimens demonstrated a proliferating trichilemmal tumor (PTT). Two years prior to experiencing headache, the man had a round mass localized in the right suboccipital scalp which recurred after wide excisions and was found to be PTT. There was no evidence of tumor recurrence at the scalp during the period the man first began experiencing headache. Although PTT usually occurrs at the scalp, direct invasion into the brain is very rare. We report a patient with malignant PTT who developed brain parenchymal inva-sion, which was supported by neuroradiological and histopathological findings.