Camptocormia with Transient Ischemic Attack

No abstract available.

Cardiovascular Autonomic Dysfunction in Mild and Advanced Parkinson's Disease

OBJECTIVE: The purpose of the present study was to investigate cardiovascular autonomic dysfunction in patients with Parkinson's disease (PD) with mild to severe stages of motor symptoms and to compare cardiovascular autonomic dysfunction between drug-naïve and dopaminergic drug-treated groups. METHODS: This study included 188 PD patients and 25 age-matched healthy controls who underwent head-up tilt-testing, 24-h ambulatory blood pressure (BP) monitoring and 24-h Holter monitoring. Autonomic function test results were evaluated among groups categorized by motor symptom severities (mild vs. moderate vs. severe) and treatment (drug-naïve or dopaminergic drug treatment). RESULTS: Orthostatic hypotension and supine hypertension were more frequent in patients with PD than in healthy controls. The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different among groups. Additionally, no significant differences were detected in supine BP, orthostatic BP change, nighttime BP, nocturnal BP dipping, or heart rate variabilities among groups. CONCLUSIONS: Cardiovascular autonomic dysfunction is not confined to moderate to severe PD patients, and starts early in the course of the disease in a high proportion of PD patients. In addition, dopaminergic drug treatments do not affect cardiovascular autonomic function.

Influence of Compression Ratio Differences between Magnetic Resonance Images and Simple Radiographs on Osteoporotic Vertebral Compression Fracture Prognosis after Vertebroplasty

OBJECTIVE: The extent of collapse progression after vertebroplasty in osteoporotic vertebral compression fractures (OVCF) has known to be various. In this study, we investigated that how much difference of compression ratio between standing simple radiograph and supine magnetic resonance imaging (MRI) affects the collapse progression after vertebroplasty. METHODS: This retrospective cohort study was carried out based on 27 patients with 31 OVCFs undergone vertebrplastyin the thoracolumbar junction (T12-L2), from January to December 2009. The OVCFs were divided to two groups, the smaller group A and larger group B, by mean compression ratio difference (8.1%) between standing simple radiograph and supine MRI. RESULTS: There were no significant differences in the baseline characteristics of the two groups except age. There were also no significant differences between the periodic compression ratio, back pain, Cobb's angle during follow-up period. However, Group B seemed to show improvements from the initial state to the point just after the operation, but eventually took a much worse course than group A. In the end, judging from the compression ratios of the two groups at the last follow up, group A showed less progression. CONCLUSION: Although the clinical outcome was not different significantly, a greater compression ratio difference in the initial study resulted in a greater collapse progression at last follow-up. Therefore, we suggest that it is important to check the initial standing simple radiograph, as well as supine MRI, for predicting collapse progression after vertebroplasty.

Resorption of Autogenous Bone Graft in Cranioplasty: Resorption and Reintegration Failure / 대한신경손상학회지

OBJECTIVE: Re-implantation of autologous skull bone has been known to be difficult because of its propensity for resorption. Moreover, the structural characteristics of the area of the defect cannot tolerate physiologic loading, which is an important factor for graft healing. This paper describes our experiences and results with cranioplasty following decompressive craniectomy using autologous bone flaps. METHODS: In an institutional review, the authors identified 18 patients (11 male and 7 female) in whom autologous cranioplasty was performed after decompressive craniectomy from January 2008 to December 2011. We examined the age, reasons for craniectomy, size of the skull defect, presence of bony resorption, and postoperative complications. RESULTS: Postoperative bone resorption occurred in eight cases (44.4%). Among them, two experienced symptomatic breakdown of the autologous bone graft that required a second operation to reconstruct the skull contour using porous polyethylene implant (Medpor(R)). The incidence of bone resorption was more common in the pediatric group and in those with large cranial defects (>120 cm2). No significant correlation was found with sex, reasons for craniectomy, and cryopreservation period. CONCLUSION: The use of autologous bone flap for reconstruction of a skull defect after decompressive craniectomy is a quick and cost-effective method. But, the resorption rate was greater in children and in patients with large skull defects. As a result, we suggest compressive force of the tightened scalp, young age, large skull defect, the gap between bone flap and bone edge and heat sterilization of autologous bone as risk factors for bone resorption.

Postoperative Cervical Cord Compression Induced by Hydrogel Dural Sealant (DuraSeal(R))

Cerebrospinal fluid (CSF) leakage is a potential complication of cranial and spinal surgery. Postoperative CSF leakage can induce delayed healing, wound infection and meningitis. DuraSeal(R) (Covidien, Waltham, MA, USA) is a synthetic product which has been increasingly used to facilitate watertight repair of dural defects after cranial and spinal surgery. Despite some advantages of Duraseal(R), the authors report a patient who developed cord compression following the use of DuraSeal(R) in cervical spine surgery in which the expansion of the DuraSeal(R) was believed to be the causative factor.

A Case of Follicular Thyroid Carcinoma Developed in Pendred Syndrome / 대한내분비학회지

Pendred syndrome is an autosomal recessive genetic disorder, which is characterized by sensorineural hearing loss, goiter and a positive perchlorate discharge test. It is caused by mutations of the PDS gene, and its clinical characteristics vary widely. The thyroid function in most cases is normal, or shows only mild hypothyroidism. In Pendred syndrome, there is an organification defect that leads to defective thyroid hormone synthesis, followed by chronic TSH stimulation. Herein is reported a case of a follicular thyroid carcinoma associated with Pendred syndrome. To our knowledge, this is the first case reported in Korea. The patient presented with a huge anterior neck mass, sensorineural hearing loss and a positive perchlorate discharge test. Fine needle aspiration cytology suggested malignancy of the thyroid, and a total thyroidectomy, with central compartment node dissection, was performed. The pathology from the thyroid mass showed a poorly differentiated follicular thyroid carcinoma

A Case of Follicular Thyroid Carcinoma Developed in Pendred Syndrome / 대한내분비학회지

Pendred syndrome is an autosomal recessive genetic disorder, which is characterized by sensorineural hearing loss, goiter and a positive perchlorate discharge test. It is caused by mutations of the PDS gene, and its clinical characteristics vary widely. The thyroid function in most cases is normal, or shows only mild hypothyroidism. In Pendred syndrome, there is an organification defect that leads to defective thyroid hormone synthesis, followed by chronic TSH stimulation. Herein is reported a case of a follicular thyroid carcinoma associated with Pendred syndrome. To our knowledge, this is the first case reported in Korea. The patient presented with a huge anterior neck mass, sensorineural hearing loss and a positive perchlorate discharge test. Fine needle aspiration cytology suggested malignancy of the thyroid, and a total thyroidectomy, with central compartment node dissection, was performed. The pathology from the thyroid mass showed a poorly differentiated follicular thyroid carcinoma

A Case of Silent Corticotroph-cell Adenoma with Elevated Serum ACTH / 대한내분비학회지

A 48 year-old man was referred to our Department with a headache, and also presented with an elevated serum ACTH level, but without an elevated serum cortisol. Although there was no clinical evidence of Cushing's syndrome, a brain CT and MRI showed a 4x4.5 cm sized pituitary mass, which was successfully removed by a transsphenoidal approach (TSA). A histopathological examination revealed the mass to have an ACTH positive reaction. Therefore, through hormonal and pathological evaluation, a silent corticotroph-cell adenoma (SCCA), with an elevated serum ACTH level, was diagnosed. Although reports on SCCA have been recently increased, this case is reported because these kinds of tumor are still rare, and those SCCA with an elevated serum ACTH even more so

Expression of RET in Thyroid Diseases of a Korean Population / 대한내분비학회지

BACKGROUND: Activation of the RET proto-oncogene, located on the long arms of chromosome 10, contributes to the development of thyroid cancers in two different ways. Somatic rearrangements of RET with variable genes of activation are frequently found in papillary thyroid carcinomas. And Ggerm-line point mutations are responsible for the development of medullary thyroid carcinoma and the multiple endocrine neoplasia type 2(MEN2). There are several conflicting reports on the influences of RET expression and RET/PTC rearrangements on the clinical outcome of thyroid cancer. Therefore, we performed an examination of RET expression and RET/PTC-1, -2, -3 rearrangements in papillary thyroid carcinomas and other thyroid diseases. METHODS: Twenty-six papillary thyroid carcinomas(PTCs), three follicular thyroid carcinomas (FTCs), one anaplastic thyroid carcinoma(ATC), five follicular adenomas(FAs), nineteen hyperplasias, and two normal thyroid tissues were included in this study. RT-PCR and immunohistochemistry analysis were done to identify RET gene, RET/PTC rearrangements, and ret RET protein expression. RESULTS: By RT-PCR, 89.4% of PTCs, 100% of FTCs, and 62.1% of hyperplasias expressed the RET gene, but no RET was observed in ATCs, FAs, and normal thyroid tissues. RET/PTC-1, -2,-3 rearrangements were not detected in any specimens. Immunohistochemical results revealed that 76.9% of PTCs, 50% of FAs, 52.3% of hyperplasias, and 20.6% of normal thyroid tissues expressed the RET ret protein, but FTCs and ATCs did not. Most PTCs showed strong cytoplasmic positivity in RET ret immunostaining, but the positive non- PTCs expressed weak and membranous staining. Overall, the two methods for detecting RET gene, RT-PCR and immunohistochemistry showed similar results. CONCLUSION: The RET gene was highly expressed in PTCs. In contrast to the previous reports of that theRET gene expression of RET gene is being limited to PTCs, RET was also expressed in hyperplasias, Fas, and normal thyroid tissues. However, the pattern and the degree of expression of the RET ret protein in non- PTCs were are different from those in PTCs.

A Case of Metastatic Pulmonary Calcification in Primary Hyperparathyroidism / 대한내분비학회지

Metastatic calcification is the deposition of calcium, in previously normal tissue, as a result of elevated plasma calcium and phosphorus product levels and has been reported in patients with parathyroid adenoma, parathyroid carcinoma, hyperparathyroidism due to chronic renal failure, vitamin D intoxication, and osteolytic bone tumors, such as multiple myelomas. The lungs are the most common site of metastatic calcification. We have experienced metastatic pulmonary calcification in a case of primary hyperparathyroidism. A 55-year old woman was admitted due to general weakness. From the laboratory evaluation, hypercalcemia and excess production of parathyroid hormone (PTH) were noted. technetium-99m-labelled sestamibi scintigraphy indicated an intense uptake in the lower pole area of the left thyroid gland, suggestive of a parathyroid adenoma. A technetium-99m phosphate (99mTc-MDP) bone scan showed increased uptakes in both lungs. A parathyroid lobectomy was performed, and primary hyperparathyroidism, due to a parathyroid adenoma, was finally diagnosed. A follow-up 99mTc-MDP bone scan showed the disappearance of the metastatic pulmonary calcification, with the clinical symptoms and biochemical parameters normalizing after 6 months.

A Case of Bilateral Macronodular Adrenal Hyperplasia with Cushing's Syndrome Treated by Unilateral Adrenalectomy / 대한내분비학회지

In order to differentiate the causes of Cushing's syndrome; whether it is pituitary or adrenal-dependent, a high dose dexamethasone suppression test is usually performed but this does not always correlated with the imaging diagnosis. We report a case of bilateral macronodular adrenal hyperplasia, which was thought to be independent to adrenocorticotrophin (ACTH) stimulation. At first we thought it was pituitary-dependent Cushing's syndrome, due to its suppression by high dose dexamethasone. However, we found no abnormal findings on the brain sella magnetic resonance image (MRI). A significant finding, however, we found bilateral adrenal masses on the abdominal computed tomography (CT). We performed percutaneous selective adrenal venous sampling (PSAVS), and confirmed hypercortisolism of the left adrenal mass only. Therefore, we decided to remove the left adrenal gland to preserve the residual function of the right adrenal gland. After the left adrenalectomy, the patient became normotensive, and their buffalo hump disappeared, and her 24 hour urinary free cortisol level returned to normal.

Metabolic significance of non-alcoholic fatty liver disease in non-obese adults / 대한내과학회지

BACKGROUND: It is well known that non-alcoholic fatty liver disease is associated with metabolic syndrome such as obesity, type II diabetes mellitus, dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-obese adults, but the meaning of it is unknown. So we studied the association of non-alcoholic fatty liver disease in non-obese adults and metabolic abnormalities. METHODS: We examined 779 Korean adults above 30 years old (274 men, 505 women) participating in medical check-up in Health Promotion Center. Hepatitis B and C serologies were negative, and average weekly alcohol intake was or=25 kg/m2, n=348) group (65.5 vs 32.3%, p<0.05). Compared with obese group, waist circumference, waist hip ratio, body fat, impaired fasting serum glucose, total cholesterol, HDL-cholesterol, total cholesterol to HDL-cholesterol ratio, fasting insulin, proinsulin, HOMA-IR and HOMA-beta were significantly different in non-obese, non-alcoholic fatty liver group. After multiple regression analysis, waist circumference was associated with non-alcoholic fatty liver disease in non-obese individuals. Odd ratios of insulin resistance in non-obese, non-alcoholic fatty liver group were 5.8 (CI: 3.1~10.9). CONCLUSION: The frequency of non-alcoholic fatty liver disease was very high in non-obese adults and well associated with central obesity and insulin resistance.

A Case of Insulinoma Combined with Pheochromocytoma / 대한내분비학회지

Multiple endocrine neoplasia (MEN) is a combination of endocrine tumor associations and consists of 3 types: 1, 2A and 2B. Herein, we report a case of insulinoma which is combined with pheochromocytoma discovered at the left adrenal gland which was treated by surgical resection. We think there is a possibility of a new type of multiple endocrine neoplasia (MEN).