Methazolamide-induced toxic epidermal necrolysis confirmed by lymphocyte activation test

Among various dermatological entities, toxic epidermal necrolysis (TEN) is a rare but potentially fatal delayed hypersensitivity reaction to numerous medications. A 38-year-old male presented with systemic hypersensitivity reaction, such as high fever, pain in the eyes, and diffuse pruritic erythematous maculopapular eruptions with multiple targetoid plaques that became vesicular and bullous. Oral mucosa and conjunctivae were involved. The first sign appeared about 1 week after taking methazolamide (50 mg twice a day) for the management of glaucomatous eyes. Although methazolamide was discontinued, blistering and skin denudation progressed to affect up to 80% of the body surface area and a positive Nikolsky sign was noted. High fever also persisted. Skin lesions started to improve after 2 weeks of management and fever subsided. Cutaneous lesions improved with minimal permanent sequele 2 months later. HLA-B*5901 was found by high-resolution genotyping. The lymphocyte activation test performed 6 months after remission showed a positive response to methazolamide challenge. This is the first case of methazolamide-induced TEN in which methazolamide was confirmed as a culprit drug by the lymphocyte activation test.

Clinical Analysis of Primary Pontine Hemorrhage

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows: 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5:3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160mmHg. 4) Outcome I and II according to ADL were only .5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.

Clinical Analysis of Primary Pontine Hemorrhage

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows: 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5:3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160mmHg. 4) Outcome I and II according to ADL were only .5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.

Normal Data of Somatosensory Evoked Potential by Posterior Tibial Nerve Stimulation

This study was undertaken to obtain the normal somatosensory evoked potential pattern from stimulation of the posterior tibial nerve in order to provide basic data for clinical use in diagnosis and management of patients with brain and spinal cord lesions. Thirty-six patients, free of neurological disease and 14 volunteers were tested with 4-Channel Nicolet CA 1000 Clinical Averager. There were 26 male and 24 female, ranging in height from 156 to 178 centimeter, with a mean height of 165.2 centimeter. The results were as follows: 1) All lumbar waves(LP1, LN1) and early cortical waves(P1, N1, P2, N2) were easily identified in all of normal subjects, but P3 was obtaind in 52% of them. 2) Mean latency of each wave was P1(38.10msec.+/-2.23), N1(47.04msec.+/-2.18), P2(N59.98msec.+/-2.97), N2(76.48msec.+/-4.97), LP1(17.99msec.+/-1.75) and LN1(20.72msec.+/-1.53). 3) There was significant correlations between height of individuals and latency of the P1 and LP1. 4) Conduction time between LN1and P1 was 16.55msec. (1.03 and mean latency of left to right difference was 0.23msec.+/-0.19.

Regional Cerebral Blood Flow Changes in Traumatic Carotid Cavernous Fistula During Trapping Procedure: Case Study, Preliminary Report

Carotid cavernous sinus fistula is abnormal communication between the carotid artery and the cavernous sinus. It can be classified according to three criteria : 1) pathologically into spontaneous or traumatic ; 2) hemodynamically into high flow or low flow fistula ; 3) angiographically into direct or dural fistula. We studied the regional cerebral blood flow changes in traumatic carotid cavernous sinus fistula. Regional cerebral blood flow checked 7 times during trapping procedure. The results are as follows ; 1) regional cerebral blood flow decreased in normal side than in lesion side hemisphere in the state of carotid cavernous fistula. 2) After compression of lesion side common carotid artery over 10 minutes, cerebral blood flow increased in both side. 3) Cerebral blood flow decreased temporary after operation on both side but normalized 2 or 3 weeks later.