Two Cases of Central Vertigo Presenting as Apogeotropic Direction Changing Positional Nystagmus / 대한평형의학회지

Positional vertigo and nystagmus without focal neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). And the apogeotropic positional nystagmus can be diagnosed as cupulolithiasis of the horizontal semicircular canal. However, cerebellar lesion involving especially nodulus could be initially presented as positional vertigo like a BPPV without other neurologic signs. In most of the patients with cerebellar involvement, initial presentation shows dysarthria, ataxia, headache, nausea, vomiting and unsteadiness. But in some central lesions, positional nystagmus might be observed in head roll test as if BPPV was presented. It is very important for clinicians of dizziness care unit to differentiate central positional vertigo (CPV) from BPPV. But it is difficult to diagnose CPV at initial visit by history and physical exam only. Therefore, we introduce two cases with cerebellar infarction and hemorrhage initially presenting isolated positional vertigo mimicking BPPV.

Clinical Usefulness of Cepstral Analysis in Dysphonia Evaluation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the present methods for assessing speech, there are procedures that make effective diagnostics possible for voice disorders. One such procedure is cepstrum. Spectrum is produced by Fourier transformation of sound waves, and if Fourier transformation is performed again about the spectrum, cepstrum is produced. This study compared cepstrum to jitter, shimmer, and noise-to-harmonic ratio (NHR) for assessment of its usefulness. Cepstrum was measured by Cepstral Peak Prominence (CPP) calculated by the Hillenbrand method and Cepstral Mean Values (CMV) calculated using the Computerized Speech Laboratory software. SUBJECTS AND METHOD: We included in the study 30 patients with vocal nodule and unilateral vocal cord palsy who were diagnosed in Kangbuk Samsung Hospital between March 2010 and May 2011, and 30 normal controls. Phonation of sustained vowel /a/ sample and running speech was subjected to acoustic analysis using CMV and CPP. Then we compared the correlation of cepstrum with other acoustic methods. RESULTS: The measured values of CPP-a were 14.16, 17.25, 20.00 and the age adjusted CPP-s values were 11.21, 12.85, 15.00 for vocal cord palsy, vocal nodule and normal group, respectively. There was significant correlation with perceptions of dysphonia (p<0.001), but in CMV-a, CMV-s, there was no significant correlation. When jitter, shimmer, and NHR were compared with cepstrum, the result showed negative correlation among the three groups but CPP values showed significant difference (p<0.001). CONCLUSION: In the assessment of voice disorders, cepstrum may be used as a reliable method for comparing other complementary analysis tools. For the acoustic analysis of voice by cepstrum, however, CPP has more reliable correlations with dysphonia than CMV.

A Case of Parapharyngeal Foreign Bodies Causing Explosion of Polyurethane Foam in Oral Cavity / 대한이비인후과학회지

Foreign bodies in the upper digestive tract are frequently encountered accidental cases in otolaryngologic fields. Oropharyngeal foreign bodies consisting of polyurethane foam have never been reported. Moreover, foreign bodies penetrating into the parapharyngeal space of neck are rare but when it does, it may also cause extensive neurovascular injuries. Polyurethanes are widely used in manufacturing industries but serious hazards of these materials have not been reported. In this article, we report a man who, presented with foreign bodies that entered as a result of an explosion of polyurethane foam in the oral cavity. The foreign body had entered into the parapharyngeal space, very close to the vertebral artery.

Body Weight Gain and Metabolic Changes in Patients with Schizophrenia during 12-Week Randomized Treatment of Ziprasidone and Risperidone / 대한정신약물학회지

OBJECTIVE: Body weight gain and metabolic syndrome are frequent adverse side effects of atypical antipsychotics. However, ziprasidone has been reported to have less effect on body weight and other metabolic parameters of patients, such as blood glucose and cholesterol. In this study, changes in the body weight and metabolic parameters were compared between the treatment groups of ziprasidone and risperidone in the patients with schizophrenia or schizoaffective disorder. METHODS: Patients shown acute exacerbation of schizophrenia or schizoaffective disorder diagnosed by DSM-IV diagnostic criteria were randomly assigned to ziprasidone 40-80 mg b.i.d. (N=56) or risperidone 1-4 mg b.i.d. (N=56) for 12 weeks. Body weight was measured before treatment and at 1st, 2nd, 4th, 6th, 12th week after treatment. The serum levels of glucose and cholesterol were checked before treatment and 12th week after treatment, and serum levels of prolactin before treatment and at 4th and 12th week after treatment. RESULTS: Less gain of body weight was shown in the patients treated with ziprasidone compared to those treated with risperidone. Mean body weight gain for 12 weeks were 0.8 kg and 3.5 kg in the ziprasidone and risperidone group, respectively. There was significant difference in weight gain between these two groups from 4th week. Serum prolactin elevation was higher in the risperidone group than in the ziprasidone group. However, there were no significant differences in the effects on the level of blood glucose and cholesterol between two treatment groups. CONCLUSION: This study shows that ziprasidone had less effect on body weight and prolactin compared to risperidone in the patients with schizophrenia or schizoaffective disorder in Korea. Although further studies are necessary to investigate the long-term effects, the less effect of ziprasidone on body weight and serum prolactin in schizophrenia and schizoaffective patients in Korea may help to enhance treatment compliance and lessen the cardiovascular risks.

Relationship of Angiopoietin-2 Expression to Atherosclerosis in Middle Cerebral and Coronary Arteries / 대한해부학회지

Atherosclerosis is a systemic and multifactorial disease, its incidence is raised recently. Cerebral and coronary atherosclerosis have some similar pathogenesis, but their relationship and mechanisms are still remain unclear. Intimal neovascularization in the atherosclerotic plaque was focused with respect to its pathological roles, intimal thickening and atherosclerotic progression. Ang-2, which is an angiogenesis regulating factor, provides a destabilizing signal for endothelial cells, leading to vessel regression or sprouting. However the role and distribution of Ang-2 in atherosclerotic coronary and cerebral arteries are still not well known. Thus, we analyzed 1) atherosclerotic lesion progression 2) relationship of atherosclerosis to Ang-2 expression in human middle cerebral and coronary artery. Paraffin sections from 25 human coronary (COA) and 36 middle cerebral arteries (MCA) were characterized according to AHA classification. In the same person, the score of atherosclerosis progression in COA was higher than that of MCA. In the two kinds of arteries having same atherosclerotic progression, the degree of intimal proliferation and luminal stenosis in COA was higher than that of MCA. Expression of Ang-2 was not shown in normal artery but localized in lumen-lining endothelium, macrophage in preatheroma, atheroma and complicated lesion. Ang-2 expression and infiltration of macrophages were rich in COA than MCA. Our result indicated that cerebral atherosclerosis has some different pathogenic mechanisms with coronary atherosclerosis according to difference of progression and angiogenic factor Ang-2 expression. Thus this is a fundamental study for understanding the progression of atherosclerosis in different vascular beds.

Pathophysiological Role of Angiopoietin-2 in Human Coronary Atherosclerosis / 대한해부학회지

Neovascularization is well known to occur in human atherosclerotic plaques; however, its pathophysiological roles, mechanism, and stimuli still remain unclear. Angiopoietin-1 and -2 belong to another vascular-specific growth factor family and regulate angiogenesis. Angiopoietin-2 (Ang-2) provides a destabilizing signal for endothelial cells, leading to vessel regression or sprouting depending on the presence of other angiogenic factor. But role and distribution of Ang-2 in atherosclerosis are not well known. Thus, we studied 1) the distribution and amount of Ang-2 2) the relationship between Ang-2 expression and vascular morphometrical change 3) the relationship between Ang-2 expression and neovascularization in atherosclerotic lesions. Paraffin sections from 36 human coronary arterial segments were characterized as normal, preatheroma, atheroma, fibroatheroma and complicated lesion according to American heart association classification. Expression of Ang-2 and related factors were examined using immunohistochemistry and western blotting with antibodies against Ang-2, CD31 (endothelial cells), alpha-actin (vascular smooth muscle cells), CD36 (monocyte & macrophage), Tie-2 and VEGF. Expression of Ang-2 was not shown in normal arterial segment. Ang-2 were localized in lumen-lining endothelium, macrophage, some SMCs of atheromatous plaque in advanced lesion. Amount of Ang-2 was increased according to progression of atherosclerosis. Intraplaque microvessels had Ang-2 and VEGF positive endothelial cells and number of those in plaque increased according to progression of disease. Intimal neovascularization is correlated with intimal thickening in atherosclerotic lesion (R2 = 0.7424). Therefore, they suggest that Ang-2 has an important role in the progression of human coronary atherosclerosis, as well as in neovascularization. This study implicates Ang-2 as an important potential therapeutic target in vascular disease

Distal Posterior Interosseous Nerve Syndrome / 대한정형외과학회잡지

PURPOSE: Chronic dorsal wrist pain limits hand function and is related to several diseases. Especially, pain and tenderness over the fourth extensor compartment with repetitive wrist dorsiflexion was described as distal posterior interosseous nerve syndrome. This article details the history, symptoms, physical findings, and treatment of this syndrome. MATERIALS AND METHODS: This study includes six patients seen between 1996 and 1998. Five men and one woman (ages 17 to 57 years) presented with localized, nonradiating, dull dorsal wrist pain, ulnar and distal to Lister's tubercle. Presumptive diagnostic test was an injection of selective lido cane 2 cm proximal to the wrist joint. RESULTS: Six patients were diagnosed of having distal posterior interosseous nerve syndrome. The five patients who recurred symptoms after injection underwent surgical exploration. Histologic evaluations revealed abnormal perineural fibrosis and edema. Patients were reexamined at least 12 months after surgery and have returned to full asymptomatic activity. CONCLUSIONS: Initially, non-operative treatment seems to be effective. If conservative treatment fails, operative excision of distal posterior interosseous nerve may be required

Lumbar Spinal Fusion with Pedicle Screw Fixation in the Elderly Patients / 대한척추외과학회지

STUDY DESIGN: A retrospective study was performed in elderly patients undergoing lumbar spinal fusion using pedicle screw fixation. OBJECTIVES: To investigate perioperative complications and surgical outcomes in elderly patients who underwent lumbar spinal fusion with pedicle screw fixation. SUMMARY OF LITERATURE REVIEW: There have been few reports regarding the lumbar spinal fusion using pedicle screws in the elderly, especially in the Korean literature. MATERIALS AND METHODS: Thirty-three patients over 60 years of age who underwent decompression and instrumented fusion with pedicle screws were retrospectively evaluated. Minimum follow-up was 2 years. We reviewed medical records and radiological films. We studied age, sex, lesion site, duration of hospital stay, operating time, amount of transfusion, clinical outcomes, complications, preoperative co-morbidity, fusion level, time at which fusion was complete, and fusion rate. RESULTS: The 33 patients consisted of 13 male and 20 female patients. Mean age was 63.8 (60-74) years. Preoperative diagnoses were spinal stenosis, 23, degenerative spondylolisthesis, 8, and spondylolytic spondylolisthesis, 2. Twenty-one cases nvolved single level and 12 cases involved multiple levels. Sixteen patients had 12 co-morbidities. The mean fusion segments ere 1.5 (1-3) segments. The mean operating time was 204.7 (115-330) minutes. The mean amount of transfusion was 2.5 (0-6) ints. The mean duration of hospital stay was 17.8 (13-29) days. Satisfactory clinical outcomes were found in 27 patients (81.8%). usion rate was 93.8%. The time at which fusion was complete was 5.6 (3-12) months. Complication rate was 21.2%. Mortality ate was 3.0%. There was a high postoperative complication rate in patients who had had medical problems before the operation, hich was statistically significant. CONCLUSIONS: Pedicle screw fixation in patients over 60 years was a useful method for the treatment of degenerative spinal disorders. However, patients with preoperative co-morbidity showed a very high medical complication rate. Therefore, careful erioperative management was recommended in high-risk elderly patients with preexisting medical problems.

Antibody response against 65kD heat shock protein in Kawasaki disease / 소아알레르기및호흡기학회지

No abstract available.