ABSTRACT
BACKGROUND: Bell's palsy (BP) is the most frequent disease of the seventh cranial nerve, and has a relatively good prognosis. However, the precise etiology of the disorder has not been well understood. During the last decade, many researchers have focused on the conditions that are associated with BP, including diabetes, hypertension, and viral infection. We therefore analyzed that the etiology and clinical course of acute BP in patients in one university hospital. METHODS: The study comprised 241 BP patients who were examined over a 60-month period. Their clinical history was taken, and neurologic examinations, laboratory tests, electrophysiologic studies, and brain imaging was performed. The clinical severity of the facial palsy was assessed using the House-Brackman (HB) facial nerve grading scale. Patients were followed up once a week during the first month, and for up to 2 months. RESULTS: Of the 241 patients, 103 (43.5%) were men and 138 (56.5%) were women, whose ages were 46.4+/-16.6 and 48.4+/-17.6 years, respectively (mean+/-SD). The initial examination revealed that 36.7% of the cohort had an HB grade below 4, while in 63.3% the HB grade was above 3. Combined symptoms were as follows: postauricular pain (77.5%), increased tear flow (23.4%), taste change (15.6%), and hyperacusis (15.1%). The initial facial nerve conduction study performed within 1 week of presentation revealed a low compound muscle action potential amplitude in 140 (57.8%) and an absent blink reflex in 225 (93%). On follow-up examination, 134 (59%) of the patients exhibited a partial improvement by 4 weeks, and 166 (79.8%) had recovered completely within 2 months. CONCLUSIONS: We describe the epidemiologic, clinical, electrophysiologic, and radiologic characteristics of BP patients at one university hospital.
Subject(s)
Female , Humans , Male , Action Potentials , Bell Palsy , Blinking , Cohort Studies , Facial Nerve , Facial Paralysis , Follow-Up Studies , Hyperacusis , Hypertension , Muscles , Neuroimaging , Neurologic Examination , Prognosis , TearsABSTRACT
Lambert-Eaton myasthenic syndrome (LEMS) is characterized clinically by fluctuating muscular weakness; presentation with ocular symptoms is unusual. A 60-year-old man had developed diplopia and ptosis 2 years previously. The findings of a neurologic examination were normal except for bilateral ptosis and ophthalmoplegia. The amplitude of compound muscle action potentials recorded on the abductor digiti minimi increased (by more than 500%) during 50-Hz stimulation. This case demonstrates that LEMS should be included in the differential diagnosis of myasthenic symptom confined to the ocular muscles.
Subject(s)
Humans , Middle Aged , Action Potentials , Diagnosis, Differential , Diplopia , Lambert-Eaton Myasthenic Syndrome , Muscles , Neurologic Examination , OphthalmoplegiaABSTRACT
BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. METHODS: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST. RESULTS: The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. CONCLUSIONS: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.
Subject(s)
Humans , Amylases , Bile Ducts , Bile , Choledocholithiasis , Common Bile Duct , Dilatation , Diverticulum , Epinephrine , Hemorrhage , Inflation, Economic , Lipase , Mortality , Pancreatitis , Sphincterotomy, EndoscopicABSTRACT
The ampullary carcinoma is a rare disease that occurs in approximately 0.2% of all gastrointestinal carcinomas and in 7% of all periampullary carcinomas. The clinical manifestations of ampullary carcinoma are anorexia, nausea, vomiting, jaundice, itching, abdominal pain, diarrhea, etc. When discovered, approximately 80% of cases are operable because of the rare regional invasion of the tumor. The 5-year survival rate after surgery is approximately 35%, but closer to 0% without surgery. Therefore the treatment of choice is surgery (pancreaticoduodenec-tomy, Whipple's operation). However, less invasive procedures are needed for patients in poor general condition, old age, and those who refuse surgery. We report a case of an ampullary carcinoma in which an endoscopic snare ampullectomy was performed as a second option after the patient refused surgery.
Subject(s)
Humans , Abdominal Pain , Anorexia , Diarrhea , Jaundice , Nausea , Pruritus , Rare Diseases , SNARE Proteins , Survival Rate , VomitingABSTRACT
BACKGROUND: Tools such as SCORE (Simple Calculated Osteoporosis Risk Estimation) and ORAI (Osteoporosis Risk Assessment Instrument) have been used for screening test of Osteoporosis, These tools include race, age, weight, BMI, previous treatment with HRT and so on, as confounding factor. Among those factors, it has been reported that body weight is more appropriate than BMI. But those study were based on Caucasian women and not based on Korean women. Therefore, comparison among Korean women needed to be assessed. METHODS: A total of 200 postmenopausal women in ages 50 and over were enrolled in health promotion center of one university hospital, BMD was checked by DXA of lumbar spine (L1-L4) from January 2002 to May, 2003. Women, who had previous history of endocrine disease or medications, early onset menopause, previous surgery of uterus and ovary, which all could influence BMD, were excluded. RESULTS: The average age was 58.01, the average weight 58.36 kg, the average BMI (kg/m2) 24.39, the average BMD (t-score) -1.00. Among the total 26 women (13%) recorded BMD (t-score)< or =-2.5 and 50 women (25%) recorded -2.5Subject(s)
Female
, Humans
, Body Mass Index
, Body Weight
, Racial Groups
, Endocrine System Diseases
, Health Promotion
, Logistic Models
, Mass Screening
, Menopause
, Osteoporosis
, Ovary
, Risk Assessment
, Spine
, Uterus
ABSTRACT
BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.
Subject(s)
Humans , Cholesterol , Cholesterol, HDL , Cholesterol, LDL , Diagnosis , Malaria , Malaria, Vivax , Parasitemia , Plasma , Plasmodium vivax , Plasmodium , Platelet Count , TriglyceridesABSTRACT
BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.