A Case of Hyperplastic Gastric Polyposis with Morphological Changes during Short Follow-up Period / 대한소화기내시경학회지

Hyperplastic polyps are often multiple and by far the most frequent lesions among gastric polyps, contributing for about 90% of the polypoid lesions observed in the stomach. However, hyperplastic gastric polyposis is rare and was not exactly evaluated for natural course. These lesions are considered reactive and not genetically determined conditions. So it has been claimed that the hyperplastic polyps and hyperplastic polyposis are non-neoplastic lesions that result from regenerative hyperplastic reaction to inflammation and erosion. Recently we experienced a hyperplastic gastric polyposis with morphological changes during short follow-up period and reported herein.

Technetium-99m HM-PAO SPECT in patients with delayed neurologic sequelae after carbon monoxide poisoning

We used single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc-HM-PAO) in 14 studies on 6 patients with delayed neurologic sequelae from carbon monoxide (CO) poisoning to determine whether any changes in cerebral blood flow could be correlated with clinical or computed tomographic evidence of delayed deficits. Among the six initial CT brain scans, two showed low density of both basal ganglia and two showed decreased density of the cerebral white matter. There was no correlation between the clinical outcome and the findings of the follow-up CT brain scans. Of the two SPECTS with 99mTc-HM-PAO performed during acute anoxic insult, one showed focal hypoperfusion which appeared 20 days prior to the onset of delayed neurologic sequelae after CO poisoning. Seven SPECTs in the six patients performing the delayed phase showed diffuse patched patterns of hypoperfusion which improved on follow-up images. There was good correlation between the clinical outcome and the findings of the 99mTc-HM-PAO SPECT. In preliminary conclusion, 9Tc-HM-PAO brain SPECT can be used for predicting or evaluating the outcome of delayed neurologic sequelae after CO poisoning. Cerebral vascular changes may be the possible cause of hypoperfusion in patients with CO poisoning.

Stroke in Young Adults

Strokes in young adults are relatively uncommon. It usually occurs in the middle-aged and elderly. Only 3-8% of all strokes occurred in patients aged 15-45 years. But despite of the small percentage of occurance. It had more various and diverse possible causes than strokes in elderly. We evaluated l63 patients aged 15-45 years who were admitted to our hospital during 1985-1989 under diagnosis of cerebral infarction. Intracerebral hemorrhage. And subarachnoid hemorrhage. This group comprised 14.4% of all ages admitted for strokes. Cerebral infarction was diagnosed in 52 patients:the possible causes were hypertension and diabetes mellitus, cardiac embolisms, meningoencephalitis. Puerperium or oral pill, polycythemia, systemic lupus erythemtosus, and etc. Intracerebral hemorrhage was found in 71 patients ; the possible causes were hypertension 'and diabetes mellitus. Ruptured arteriovenous malformations, ruptured aneurysms, Moyamoya diseases, end stage renal disease, and etc. The remaining 40 patients had subarachnoid hemorrhage almost all from ruptured aneurysms. From the above results we found strokes in young adults had various possible causes, and extensive, tailored studies are needed for diagnosis.

Three Cases of Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a kind of chronic neurodegenerative diseases, the main clinical characteristics of which are loss of voluntary control of vertical gaze, particularly downgaze, dysarthria. Diffuse body rigidity with dystonic extension of the peck, and dementia In its earlier stages, PSP can be misdiagnosed as Parkinson's disease because of lack of awareness of the disease and symptoms and signs may not be diagnostic until the disease is advanced. About 4% of all patients with parkinson's disease turn out eventually to have progressive supranuclear palsy. We report the three cases of PSP with MRI brain scan.

The Therapeutic Effect of Drug in Parkinson's Disease

Two hundred and four patients with Parkinson's disease initially treated wth a combination of levodopa and carbidopa ( Sinement 25-250 ) and / or anticholinergic drugs. All patients responded initially to drug. Sixteen patients(7.8%) had 20 acute central nervous system side effects: 8, dyskinesia: 6, visual hallucination:5, psychosis: and 1, akathisia. The response to treatment usually was stable for the first one and a half to four years of drug therapy. Subsequently, over 50 percent of patients had therapeutic failure among 82 patients with long term drug therapy, fourteen(l7.0%) had 18 side effects: 8, on-off phenomenon: 4. Morning dystonia: 3, dyskinesia:and 3, simultaneous dyskinesia with parkinsonism. None had diphasic dyskinesia or myoclonus. The prognosis of the demented parkinsonian was relatively poor. Two patients died due to pneumonia and ovarian carcinoma.

Intussusception into the enteroanastomosis after Billroth II gastric resection; diagnosed by gastroscopy

A case of retrograde intussusception (acute type) of efferent limb into Braun side-to-side jejuno-jejunal anastomosis is presented. Intussusception, though infrequent, is well recognized complication after gastric surgery. Patient was 50 year old man who was admitted with epigastric pain and abdominal mass for 6 hours. Patient had a history of total gastrectomy 2 years before admission due to stage II gastric cancer. Seven hours after admission, hematemesis developed. Emergency fiberopticgastroscopy revealed type 4 jejunogastric intussusception. Segmental resection with end-to-end reanastomosis was performed.

A Case of CMV Encephalitis in the Immunologically Normal Adult

Infection with cytomegalovirus(CMV) during adult life was first recognized in debilitated patients with compromised immune mechanisms, renal transplant recipients, and patients undergoing extracorporeal perfusion or transfusions. CMV infection is very rare in inmunologically normal adult. Recently CMV infection has been reported previously healthy adult, usually wth a predilection for involvement of lung, liver, spleen, hematopoietic system, or heart but central nervous system involvement is apparently rare. This report describes a previously healthy woman who had encephalitis and documented CMV infection by serologic test for CMV. So we report a case with brief review of literature.

A Case of Adynamia Episodica Hereditaria

This is a case report of 32 year-old man with adynamia episodica hereditaria. Adynamia episodica hereditaria is a rare disorder characterized by episodic atacks of muscle weakness occuring in association with an increased serum concentration of potassium. The disorder is usually inherited as autosomal dominant trait and myotonia can be seen in much of the cases. And it is uncertain whether adynamia episodica hereditaria and paramyotonia congenita are variable manifestations of the same disease or not. We now reporta case of adynamia episodica hereditaria with myotonia with the special reference to pathophysiology of paralysis and myotonic symptom.

Olivopontocerebellar Atrophy

Between 1985and 1987, 31 patients with sporadic olivopontocerebellar atrophy (SOPCA) and 3 patients with familial olivopontocerebellar atrophy (FOPCA) were examined in the Neurologic Clinic of Yongdong Severance Hospital. The incidence of the disease among our neurology clinic patients was 0.9% and 3.4% of those patients were admitted. Seventeen of them were men and seventeen women, and their ages of onset ranged from 16 to 75 years (mean, 48.2 years). In comparison with SOPCA, the disease began earlier in FOPCA (mean age, 51.0 VS 19.3 years), but there were no other differences in clinical feature of the disease. Four patients had parkinsonism, one dementia, and one ophthalmoplegia. None presented spinal involvement or abnormal movements. Eight had a coexisting disease; 3, ch(03)nic alcoholism; 2, hypertension; 2, diabetes mellitus; and 1, malignant neoplasm.

A Case of Idiopathic Orbital Myositis

Idiopathic orbital myositis, a subgroup of previously so called inflammatory orbital pseudotumor, occurred with acute onset periorbital pain, eyelid swelling, proptosis, and ophthalmoplegia. Currently many pathologist and ophthalmologist agreed the term pseudotumor or Tolosa-Hunt syndrome and They classified some cases as characterized histologic and computerized tomographic evidence of inflammation of extraocular muscles, good responsiveness to prednisone, remission and exacerbation, with recurrence, but generally benign condition. The possibility of idiopathic orbital myositis being an immune-mediated process has been discussed. Some believe many of such cases have been grouped under the term Tolosa-Hunt syndrome. It is onloy in the last decade that computerized tomographic scanning has allowed precise localization of the alterations to orbital and retro-orbital strcutures. The term idopathic orbital myositis is precise insofar as it indicates the structures primarily involved ocular muscles. We report a case of idiopathic orbital myositis withr review of literatures.

HM-PAO SPECT Brain Scintigraphy in a Patient with the Syndrome of Chronic Encephalitis and Epilepsy

Both interictal Tc-99m hexamethyl-propyleneamine oxime single photon emission computed tomography (HM-PAO SPECT) brain scintigraphy was done in a patient with the syndrome of chronic encephalitis and epilepsy. The low density area in the temporo-occipital lobe on brain CT scan revealed decreased radioactivity during interictal state and it was reversed to increased radioactivity during ictal state on HM-PAO SPECT brain imaging. In authors' opinion, ictal and interictal Tc-99m HM-PAO SPECT brain scintigraphy could be a safe and convincing study for Searching epileptogenic foci.

A Case of Dystonia Musculorum Deformans

No abstract available.

The Measurement of Plasma B-Endorphin in Acute Carbon Monoxide Poisoning

Pathophysiology of acute carbon monoxide poisoning is not clear. It is generally accepted that hypoxic and/or anoxic insult is very significant role in the pathophysiology of acute acrbon monoxide poisoning, but many arguments are documented especially focal hypoxia or metabalic acidosis within brain parenchyme. In sofar such a focal change seems to be largely depend upon focal change of neuroendocrine substances including B-endorphin. Also B-endorphin is known to be responsble to the pathogenesis of cerebral ischemia. Though the possible relationship between the alteration of level of B-endorphin and hypoxia, it is seldom to pay attention to the role of B-endorphin in carbon monoxide intoxication. We measured plasma B-endorphin in acute carbon monoxide intoxication and compared with the value of control group. There was no difference between control group and acute carbon monoxide poisoning group, the possible role of B-endorphin in acute carbon monoxide poisoning should not be excluded. We suggest the more comprehensive and newly programmed study seems to need for clarifying the possible role of B-endorphin in acute carbon monoxide poisoning.

A Case of Dyke-Davidoff Syndrome

Dyke-Davidoff syndorme is a rare congenital disorder which developed hemiatropy of brain, enlargement of ventricles and prominent pneumatization of petrous pyramid of the temporal bone. It mainfests unilateral invountary movement such as seizure, athetosis, chorea and mental retardation. This disorder have strong evidence of significance to differential diagnosis of cerebral palsy because of different therapeutic approach and outcome. Recently we examined 10 years old girl who developed seizure at 2 years old and gradually progressed with hemiparesis, hypoplaisa of right side of the body. The brain CT scan showed marked dilatation of lateral ventricle, prominent sylvian fissure and cortical sulci with somewhat thickened skull vault and pneumatization of petrous pyramid of the temporal bone on left side. EEG showed high voltage slow wave and spikes. So we report a case of Dyke-Davidoff syndrome with review of literature.

A Case of Palatal Myoclonus Caused by Trauma

Palatal myoclonus is a rare disorder described as separable from the general group of myoclonias as a clinical and antomical entity result from lesion involving the dentato-rubro-olivary pathway and the inferior olivary nucleus. This 21-year-old man was injured in a fall from the roof. On admission to the hospital, he had cerebral contusion and occipital bone fracture with other multiple trauma. On the eleventh day after the injury, he began showing rhythmic, 150/min, bilateral contraction of the palate. This movement disorder has hitherto been considered untreatable when idiopathic origin. But several reports describe improvement of palatal myoclonus during sleep or medical treatment. In this case, palatal myoclonus was absent during sleep and it responded well to oral administration of clonazepam. We report a case of palatal myoclonus which developed after trauma for the first time in Korea.

A Case of Folate Deficiency with Neurologic Involvement

A 27-year-old female patient with peripheral neuropathy and posterior column dysfunction showed severe folate deficiency in contrast to normal vitamin B12 level. Clinical manifestations improved and serum folate level rised with folate therapy. A brief review of literature was made.

A Clinical Study of 11 Patients with Meige's Syndrome

Meige's suydrome is a disorder of adults, and is characterized chiefly by prolonged symmetric dystonic contractions of the orofacial muscles. Eleven patients with prominent orofacial dystonia of unknown cause (Meige's syndrome) were examined at the department of neurology of Yongdong Severance Hospital, Yonsei Unversity Medical Center, and the following results has been obtained. 1. There were 3 men and 8 women. 2. Their ages ranged from 31 to 60 years (mean. 51.2), with the peak incidence in the 6th decade (7 of 11 patients). None of the patients was younger than 30. 3. Blepharospasm was the initial symptom in 11 patients. All patients developed the complete syndrome, blepharospasm and oromandifular dystonia. 4. Response to medication was inconsistent, but 6 of 8 patients trials resulted in some improvement: one with complete remission and 3 with marked imprvement. Clonazepam and trihexyphenidyl (Artane) were useful for the treatment of Meige's syndrome.

A Clinical Study of 16 Patients with Ataxic Hemiparesis

A clinical study was carried out in 16 patients with ataxic hemiparesis who were seen at Young Dong Severance Hospital, and following results were obtained. 1. The age of patients ranged from 37 to 80 years (mean 61.6) and there were 10 men and 6 women. 2. The etiologies were infarction (13 patients), hemorrhage (1 patient), tuberculosis (1 patient), and unknown (1 patient). 3. The sites of lesion were pons (8 patients), internal capsule (4 patients), pons and midbrain (2 patients), midbrain (1 patient), and thalamus (1 patient). 4. The symptoms other than ataxic hemiparesis were dysarthria in the lesion of pons, cranial nerve deficits and dysarthria in the lesion of midbrain, and sensory deficits in the lesion of internal capsule. Usually ataxic hemiparesis is known as a classic form of lacunar symdrome. But now, it is known as a only symptom comples, not a disease entity, that comes by any lesion involving both cortico-spinal tract and dentato-rubro-thalamo-cortical pathway or contico-pontine fiber or ponto-cerebellar fiber.

Two Cases of Chorea Caused by Caudate Infarct

In the 2 patients with hemichorea brain CT scan reveals hypodensity on the contralateral caudate nucleus and the region near contralateral caudate nucleus. The pathoanatomy of similar cases in literature are reviewed with the reference to the location of responsible lesions.

Two Cases of Isolated Medial Rectus Muscle Palsy

The isolated medial rectus muscle palsy without involvement of third cranial nerve is relative rare. Two cases were studied by coronal, transverse, axil computed tomography and MR imaging which showed the well visualization of intraorbital structures and confirmed same finding by operation with clinical improvement. It seemed to be necessary to study by comprehensive radiology for the exact localization and observation of intraorbital structures. We report two cases of isolated medial rectus muscle palsy associated with mucocele.