A Case of Monochorea Caused by a Striatal Lesion

The sudden onset of involuntary movement is usually attributed to a vascular lesion in the contralateral deep hemispheric structure. A majority of involuntary movement cases record that all the limbs on one side are affected. The concurrence of venous and cavernous malformations may be relatively rare, but is important because of the possibility of bleeding which should be related to the presence of cavernous angioma. A 67-year-old woman was admitted to our hospital to be evaluated for choreic movement restricted to the right leg for 20 days. A brain MRI revealed hemorrhage with the cavernous angioma involving the left striatum and adjacent venous angioma. Haloperidol diminished the monochoreic movement. We report monochoreic movement restricted to the right leg due to a left striatal lesion.

Treatment of Arteriovenous Fistula Failure: Surgical Revision Versus Interventional Radiologic Procedure A prospective randomized study on secondary angioaccess procedure

There are over 10,000 individuals in Korea who require chronic hemodialysis treatment. Vascular access with an adequate blood flow and good long-term patency are important to have adequate dialysis. Thrombosis is the most common cause of angioaccess failure and is usually due to outflow stenosis. A thrombolysis using urokinase has been used frequently in recent years for treatment of a thrombosis, but its efficacy is not well documented in the literature. The authors report a prospective randomized study comparing a surgical revision versus a thrombolysis with and without luminal balloon angioplasty. The long-term patency and the total cost of treatment to the patient were compared.

Heterogeneity of Renal Pathology in Korean NIDDM Patients with Microalbuminuria / 대한내과학회지

OBJECTIVE: It was suggested that the cause of microalbuminuria is heterogeneous in NIDDM. However, only a few studies are available that investigated the renal pathology in NIDDM patients with microalbuminuria. This study was undertaken to evaluate renal pathology in Korean NIDDM patients with microalbuminuria. METHODS: Fifty NIDDM patients with microalbuminuria and without retinopathy were undertaken renal biopsy. Renal pathologic findings were classified as follows: group A, near-normal finding; group B, typical diabetic nephropathology; group C, atypical patterns of renal injury (mild glomerular change with disproportionally severe tubulointerstitial lesion, arteriolar hyalinosis or global glomerular sclerosis); group D, non-diabetic renal lesion. RESULTS: Seventeen patients were classified into group A, 19 into group B and 8 into group C. Six patients had non-diabetic renal lesions and they were all confirmed to be IgA nephropathy. Fasting blood sugar and GFR were significantly higher in group B than in group A and group C respectively, and systolic blood pressure was higher in group C than in group A. CONCLUSION: Renal pathology in microalbuminuric NIDDM patients without retinopathy was heterogeneous. This may explain heterogeneous clinical meaning of microalbuminuria in NIDDM.

Prevalence and risk Factors of renal artery stenosis in patients und undergoing coronary angiography / 대한내과학회지

OBJECTIVES: The distributive pattern of atherosclerotic vascular disease is known to be different among the races. In Caucasian population, renal artery stenosis (RAS) was reported to be a frequent finding in the patients with ischemic heart disease (IHD), ranging from 5% to 29%. We investigated the prevalence of RAS and the risk factors in Korean patients. METHODS: Over a 12-month period, 574 patients (M:F, 407:167) with clinical IHD underwent cardiac catheteriza tion. Before the procedure, demographic data, medical history, physical findings, and blood chemistries were ob tained. During the procedure, selective renal arteriogram was also obtained. The degree of renal artery stenosis was quantitated with automatic edge detection technique, and narrowing of diameter greater than 50% was considered to be significant. RESULTS: RAS was identified in 42 patients (7%), of whom 5 patients (1%) had bilateral disease. Angiographi cally significant coronary artery disease was present in 473 patients. The prevalence of RAS in patients with single, double and triple vessel disease of coronary artery were 4% (9/235), 13% (20/154), and 12% (10/84), respec tively. Among the 101 patients with normal coronary arteries, 3 (3%) had RAS. By univariate analysis, there was significant difference between RAS and non-RAS in age (66+/-8 yrs vs 59+/-10 yrs, p<0.0001), duration of hypertension (7.3+/-1.3 yrs vs 3.40.3 yrs, p=0.0002), and the frequency of double or triple +/-coronary artery disease (p=0.004). However, no association was found between RAS and serum lipids, lipoprotein(a), creatinine, sex, smoking, diabetes mellitus, or peripheral vascular disease. By multivariate logistic regression analysis, the following parameters were independent risk factors for RAS: age over 65 years (p<0.001), duration of hypertension (p=0.003), and coronary artery disease involving double or triple vessels (p=0.004). CONCLUSION: The prevalence of RAS in Koreans is somewhat lower than in western population. However, in patients with high degree coronary heart disease, old age over 65 years, or long history of hypertension, the possibility of combined RAS should be considered.

Serum Lactate Levels in CAPD Patients with Liver Cirrhosis / 대한신장학회잡지

Lactate is the most commonly used buffer in CAPD. The buffering effect of lactate is accomplished by its complete metabolism in liver and kidney. In patients with hepatic disease the rate of metabolism may be lower with a consequent increase in plasma lactate levels. Plasma lactate levels, however, have not been measured in CAPD patients. This study was performed to evaluate the plasma lactate levels and acid-base status in CAPD patients with liver cirrhosis. The concentrations of arterial L-lactate, pH, bicarbonate and venous total CO2 were measured in 6 CAPD patients with LC, 36 CAPD patients without liver disease and 17 LC patients. All CAPD patients used commercially available dialysate containing 40mmol/L lactate(D,L-racemic solution). Arterial lactate levels were 4.19mmol/L in CAPD patients with LC, 1.43mmol/L in CAPD patients and 1.94mmol/L in LC patients(p<0.05). Arterial pH were not different among subgroups. Arterial bicarbonate concentrations were 20.5meq/L in CAPD patients with LC, 24.2meq/L in CAPD patients and 24.4meq/L in LC patients. Venous total CO2 levels were 21.4, 24.7 and 23.4meq/L, respectively. Anion gap were 13.1, 9.4 and 8.1, respectively. From our results and possible toxicity of elevated lactate levels, lactate-containing PD solutions should be used carefully to treat CAPD patients with LC.

A case of insulinoma localized by endoscopic ultrasonography / 대한내분비학회지

No abstract available.

Primary Chondroid chordoma Arising from the Base of the Petrous Temporal Bone: Case Report

The authors report an unusual case of a primary chondroid chordoma arising from the base of the petrous temporal bone. A 43-year-old female presented with left sided facial weakness and left sided jugular foramen syndrome. The CT findings of a tumor arising from the base of left petrous temporal bone and it involved left cerebello-pontine angle, and extended through left jugular foramen to parapharyngeal space. The clinical and histopathologic differences between classical(typical) chordoma and its variant are highlighted. The rarity of primary chordomas at this site is stressed.

A Case of Brain Necrosis Following Radiation Therapy

Cases of brain necrosis following the radiation therapy of brain tumor have been reported, and in the most cases postirradiating brain damage are usually interpreted as a recurrence of the tumor. The Authors report here a case of postirradiation brain necrosis in the left frontal astrocytoma 4 years after operation. Patient's manifestations are headache, vomiting, right sided hemiparesis and focal seizures which after developing generalized seizures in association with signs of increased intracranial pressure. CT scan showed a large cystic mass in the left frontal lobe which was verified to be necrosis on operation.

Localized Cervical Adhesive Arachnoiditis

We have experienced 3 cases of localized cervical adhesive arachnoiditis. 2 of them had history of operation under spinal anesthesia. Paresthetic pain and weakness are the commonest presenting symptoms and signs in our cases. Myelographically, findings are simulating the intramedullary lesion in 2 cases. With surgical intervention, 2 cases have good results.

Transdural Extension of Malignant Astrocytoma

Of the case of malignant astrocytoma, spontaneous transdural extension is very rare. Only several cases of transdural extension of primary intracranial tumor are reported. However, these cases are through the foramina of the skull base. We have experienced a case of malignant astrocytoma which directly extended out through the dura and calvarium near the pterion of the left side.

Aphasia in Multiple Sclerosis

Aphasia as clinical manifestation of cerebral multiple sclerosis is a rarity. We report here a clinical case of multiple sclerosis complicated by striking motor aphasia. A 11 year old male was admitted with sudden onset of aphasia and quadriparesis following appendectomy under the general anesthesia. A few hour after operation, above symptoms and bilateral pyramidal signs were developed. These findings were fluctuated but slowly remitted. Two weeks later second bout of multiple sclerosis developed, characterized by absent spontaneous speech, quadriparesis, multiple cranial nerve palsies internuclear ophthalmoplegia and bilateral pyramidal signs. The finding of E.E.G. disclosed paroxysmal slow waves in high amplitude on frontal region. Patient was treated with steroids and conservative management. Eleven weeks later, he was discharged with relatively good results.