Parkinson's Syndrome Caused by Organophosphate Intoxication: A case report

Organophosphate intoxication causing the extrapyramidal symptom is not frequent. A case of Parkinson's syndrome caused by organophosphate intoxication was observed, of which is reported with the quantitative measurement of tremor using Tri-axial accelerometry. A fifty nine year-old male was admitted to Wonju Christian Hospital after the intake of organophosphate for the purpose of suicide and three days after the accident, involuntary movements were detected. The encephalography and MRI showed no abnormality. With Tri-axial accelerometry, we detected less than 4 Hz resting tremor. The tremor did not response to L-dopa, and in the follow up examination performed 149 days after the accident, an increase in amplitude was detected. Gait disturbance and dysarticulation became more severe. In a case of the organophosphate intoxication patient, very rare Parkinson's syndrome findings were detected, and the tremor during the resting period was measured quantitatively by electromyography and Tri-axial accelerometry.

Percutaneous Balloon Compression of Trigeminal Ganglion for the Treatment of Idiopathic Trigeminal Neuralgia : Experience in 50 Patients

OBJECTIVE: We assessed the surgical results of percutaneous balloon compression in 50 patients with idiopathic trigeminal neuralgia. METHODS: Fifty patients with follow-up period of more than 12 months were retrospectively analyzed. The mean follow-up period was 42 months (range, 12-82). The mean age was 65.8 years (range, 27-83). Seventeen patients (34%) had other previous surgical procedures. The balloon was inflated by injecting radio-contrast media under brief general anesthesia according to Mullan's technique. The mean inflating time was 88 seconds (range, 60-120). The whole procedure took about 20 minutes. RESULTS: We reported excellent and good results in 70% of the cases, poor in 6% as annoying dysesthesia, recurrence in 16%, and 8% failure due to technical deficiencies. Forty-six patients (92%) were initially relieved of their pain. There were permanent motor weakness of the masseter muscle in 4% of patients and transitory diplopia in 8%. Neither anesthesia dolorosa nor keratitis occurred. Almost all patients (92%) were discharged postoperatively within two days. CONCLUSION: These results indicate that balloon compression would be an effective method with acceptable morbidity, technically, it can be performed rapidly and simply in the treatment of idiopathic trigeminal neuralgia.

Lateral Third Infraclavicular Implantation of the Vagal Nerve Stimulation Generator Through Axillary Incision

OBJECTIVE: This report describes the clinical study of the surgical method of lateral third infraclavicular implantation of vagal nerve stimulation (VNS) generator through the axillary wrinkle incision. METHODS: In a retrospective study, the data for 20 patients with medically intractable epilepsy treated by this approach were examined. The mean age was 31.4 years (range : 14-50), and the mean follow-up period was 12.15 months (range : 4-21 months). The male to female ratio was 2.3 : 1. The subcutaneous pocket for the generator was located in the lateral third infraclavicular area through the axillary wrinkle. Our method was a modification of the standard VNS generator implantation in the mid-infraclavicular pocket through anterior axillary incision. RESULTS: There were the excellent or good cosmetic satisfaction in 95% of the cases and fair in 5%. The generator was located outside the lung field in 15%, periphery of the lung field in 45%, and crossed over the lung field in 40%. Discomfort from shoulder motion occurred transiently in 35% of cases. Other complications were minimal. CONCLUSION: These results demonstrate that the lateral third infraclavicular apporach will offers cosmetic benefits and reduction of obscuration of the lung field without serious complications. Thus, this technique provides an attractive alternative among the surgical techniques for the vagal nerve stimulation.

Rehabilitation for Ambulation of Triple Amputee: A case report

Triple amputee is an uncommon impairment and has been rarely reported. We reported a case of success in independent bipedal ambulation of a triple amputee with bilateral lower limb prostheses. We selected a thirty five-year-old male who underwent a left shoulder disarticulation and a left very short transfemoral amputation and a right transfemoral amputation due to trauma. After program of gait training for eight weeks, he could walk independently, donning right hip disarticulation prosthesis and left transfemoral prosthesis and left shoulder disarticulation prosthesis with right Lofstrand forearm orthosis. We measured the amountof oxygen consumption of the patient before and after rehabilitation program done, of which all parameters including oxygen consumption were more improved than before that program. The patient preferred to walk by himself and got a feeling of full achievement. Nevertheless higher energy consumption, young active triple amputees need fitting prostheses with intensive rehabilitation training program for bipedal ambulation to prevent deterioration of physical function and mental health due to immobilization.

Effects of Electrical Stimulation of Transcutaneous Electrical Nerve and Acupuncture Stimulation in Patients with Myofascial Pain Syndrome

OBJECTIVE: To evaluate the effective stimulating mode of transcutaneous electrical nerve stimulation (TENS) and acupuncture for pain relief. METHOD: The subjects were 40 patients with MPS. In 20 patients, TENS were applied to the trigger point. In other 20 patients, acupuncture mode electrical stimulation were applied to the acupuncture site by measuring skin impedance of affected muscle. RESULTS: The visual Analogue Scale (VAS) decreased 20.48 (19.15%) in the group applied TENS mode and 30.08 (16.97%) in the group applied acupuncture mode after 1 week. The VAS decreased 33.19 (25.76%) in the groupapplied TENS mode and 46.48(17.76%) in the group applied acupuncture mode after 2 week (p<0.05). The pressure threshold was increased 16.07 (17.45%) in the group applied TENS mode and 26.09 (22.20%) in the group applied acupuncture mode after 1 week. The pressure threshold increased 24.88 (23.25%) in the group applied TENS mode and 41.11 (27.35%) in the group applied acupuncture mode after 2 week. CONCLUSION: Acupuncture mode was more effective treatment modality in MPS for pain relief than TENS mode.

Squamous Cell Carcinoma of Oral Cavity and Metachronously Developed Hepatocellular Carcinoma Arising from Fanconi's Anemia

Fanconi's anemia (FA) is a rare familiar form of aplastic anemia (AA) that is associated with increased chromosomal instability and defective DNA repair, and it characterized by progressive pancytopenia, skeletal abnormalities, hyperpigmentation, and an increased risk of leukemia, hepatocellular carcinoma (HCC) and squamous cell carcinoma (SCC), including head and neck SCC. We reported a 31-year-old man who had AA for 17 years and who developed SCC of oral cavity and then metachronously developed HCC. For treatment of his AA, he was given cyclosporin, steroid and androgen in addition to frequent blood transfusion. At the age of 27, he presented with SCC of the maxilla and the right maxillectomy was performed. Four years later in 2003, hepatic resection of the left medial segment of the liver was performed due to hepatocellular carcinoma. Confirmation of FA was done by cytogenetic analysis. The patient died in 2005 of subdural hemorrhage and pneumonia without involvement of the SCC and HCC.

The Change of Skin Temperature after Thoracic Sympathectomy in Patients with Palmar Hyperhidrosis

OBJECTIVE: The purposes of this study were to evaluate the change of temperature before and after thoracic sympathectomy in patients with palmar hyperhidrosis and to find the usefulness of infrared thermography for the assessment of effects of thoracic sympathectomy. METHOD: The skin temperature was measured before, one day and 30 days after sympathectomy in 28 patients with palmar hyperhidrosis. Temperature was recorded on forehead, cheek, neck, axilla, umbilicus and 6 sites of each hand and foot by infrared thermography and thermometer. Patient's satisfaction with operation was assessed by 10 point scale. RESULTS: All patient who had undergone sympathectomy showed significantly decreased discomfort owing to hyperhidrosis by 10 point scale (p<0.05). The temperature significantly elevated on postoperative 1 day and 30 days on both palms as compared with preoperative state, bilaterally (p<0.05). There were no significant differences of sole temperatures among preoperative, postoperative 1 day and postoperative 30 days, bilaterally. CONCLUSION: We proved significant effect of thoracic sympathectomy to the patients with palmar hyperhidrosis objectively, and we also quantified the elevation of palm temperature after sympathectomy.

Hepatoblastoma in a Patient with Familial Adenomatous Polyposis: Case Report

Familial adenomatous polyposis and hepatoblastoma are rare conditions; the latter is closely related to the FAP gene. We describe the imaging findings of hepatoblastoma in a patient with polyposis coli.

Intrahepatic Cholangiocarcinoma with Sarcomatous Change: Case Report

Cholangiocarcinomas have several histologic types, but intrahepatic cholangiocarcinoma with sarcomatous change is rare. A 71-year-old man was admitted to our hospital because of fever which had lasted two months. Ultrasonography (US) of the upper abdomen demonstrated a huge hepatic mass with central solid and peripheral cystic portions, and computed tomography (CT) revealed a heterogeneous hepatic mass with a central area in which enhancedment was delayed. Magnetic resonance imaging (MRI) disclosed a huge mass of predominantly low signal intensity at T1WI, and peripheral portions of high signal intensity and a central portion of intermediate signal intensity at T2WI. The pathologic diagnosis was cholangiocarcinoma with sarcomatous change.

Three Cases of Conservative Management of Ectopic Pregnancy Implanting in The Previous Cesarean Section Scar / 대한산부인과학회잡지

Ectopic pregnancy developing in the previous cesarean section scar is the rarest forms of ectopic pregnancy and very dangerous because of the risk of uterine rupture and hemorrhage. Hysterectomy was usually done in the management but, conservative treatment is desirable for young women who want to maintain her fertility. We present three cases of ectopic pregnancy developing in the previous cesarean section scar in which successfully treated with conservative management.

A Case of Primary Endometrial Squamous Cell Carcinoma / 대한산부인과학회잡지

The development of primary squamous cell carcinoma in the endometrium is extremely rare. In 1928 Fluhmann proposed three criteria to establish the diagnosis: (1) no coexisting endometrial adenocarcinoma, (2) no connection between the endometrial tumor and the squamous epithelium of the cervix and (3) no squamous cell carcinoma of the cervix present. More recently, the World Health Organization (WHO) updated Fluhmann's criteria by adding that the tumor must contain clear evidence of squamous differentiation, such as the presence of intercellular bridges and/or keratin. We have experienced a case of primary endometrial squamous cell carcinoma which fulfills Fluhmann's criteria and WHO's. In this report, we present the clinical and pathological findings of a case of a primary endometrial squamous cell carcinoma of a 62-year-old patient with a review of the concerned literatures.

Comparison of Antimicrobial Efficacy of Topical Antibiotics in Rabbit Keratitis Model with Ciprofl oxacin, Methicillin-Resistant Staphylococcus Aureus

To compare the antimicrobial efficacy of several antibiotics in the treatment of ciprofloxacin and methicillin-resistant staphylococcus aureus(MCRSA)keratitis, we established a rabbit keratitis model by using MCRSA isolated from keratitis patient. A strain of MCRSA, approroximately 100 colony forming units in 10 microliterof phosphate buffered saline was injected intrastromally into the each cornea of New Zealand white rabbits. 30 rabbtits(30 eyes)were randomly divided into 5 groups and treated with either 0.3%ciprofloxacin, 0.3%trovafloxacin, 5%vancomycin, 5%cefazolin, or sterile deionized water.Topical antibiotics were administered every 15 min for 6 hours(750microliter). Rabbits were sacrified 1hour after the last eyedrop, and excised corneas were homogenized, diluted, and plated on BAP medium.Bacterial colonyforming units per cornea were quantified after 48-hour incubation. Aqueous humor were collected from each eye and drug concentration was counted with HPLC. The log1 0 value of colony forming units(CFUs)of vancomycin treated group was 4.85+/-0.64;ciprofloxacin, 6.16+/-0.46;trovafloxacin, 6.58+/-0.29;cefazolin, 6.25+/-0.25;and sterile deionized water, 6.57+/-0.33.In view of mean CFU, vancomycin showed greater antimicrobial activity and it was statistically significant(p<0.05). However, all of these treatment did not completely sterilize any corneas with 6-hour treatment. From these results, only topical vancomycin(5%)represented effective antimicrobial activity with short-term treatment in rabbit keratitis with MCRSA.

A Case of Progressive Recurrent Symblephron, Treated with Amniotic Membrane and Autograft Limbal-conjunctiva

Although both medical and surgical approaches have been investigated, recurrent symblepharon due to chronic ocular surface inflammation is a difficult disease to manage.This condition can also result in many complications such as cosmetic and visual deteriorations.In this condition, we can use the amniotic membrane transplantation that has a biological contact inhibition effect for the prevention of recurrent symblepharon. We treated successfully a case of a progressive symblepharon involving central cornea from 2-year old. The 14 year-old male patient had suffered from serious cosmetic problem and undergone multiple dissection, argon laser photocoagulation, using cyclosporin eyedrops. He was treated using allograft amniotic membrane, autograft limbal-conjunctiva, and buccal mucosa transplantation. we think that amniotic membrane transplantation was very effective method for the prevention of recurrent symblepharon.

A Modified Quadrantectomy Through Circumareolar Incision for Patients with Breast Cancer / 한국유방암학회지

Bast conservation therapy has become an accepted method of primary treatment for the early stage breast cancer. The extent of local excision and skin incision has been in controversy, owing to the risk of local recurrence and cosmesis. To improve breast cometic apperance following quadrantectomy for breast cancer, authors propose a novel surgical technique that is carried out local excision through circumareolar skin incision, remodeling of breast ot replace the volum loss. Level I&II axillary dissection were performed and radiotherapy were followed. Twenty-one patients underwent the novel method for breast conserving surgery from September 1995 to October 1998 in the department of surgery at Soonchunhyang University Hospital. Cosmetic outcome was evaluated by means of panel assessment and breast retraction assessment (BRA). The mean age of patient was 43.3 years(30 to 67 years). The distribution of the 22 tumors were located in the right of 11, left of 9 and both breast of 1. The mean fumor size was 1.7 cm(0.5 to 2.8cm). The type of histology was 5 of ductal carcinoma in situ, 13 infiltrating ductal carcinoma, 2 of tubular carcinoma and 1 medullary carcinoma. Five of 22 patients had metastases in the axillary nodes. The cosmetic evaluation was performed by the 3 panelist who scored it a 5-panel scale (E0 to E4). Eighteen cases were scored as E0 (excellent, 81.8%), 1 case as E1 (good), 1 case as E2 (moderate) and 2 cases as E3 (bad) cosmetic results. BRA values were calculated by simple vector geometry employing the Pythagorean theorem, BRA values for the patients ranged 0.5 to 4.4 cm with a mean of 1.6 cm and for a group of 30 control women values ranged from 0.4 to 1.8 cm with mean value of 0.9 cm. When panel scores and BRA values were compared, 18 cases of excellent (E0) scoring had under the 3.5 cm of BRA value. One of two cases with bed (E3) score had over 3.5 cm of BRA vale. Eighteen cases who were less than 60 years old had satisfactory cosmetic results by panel scoring and BRA value. Twenty one cases who underwent a novel method for breast conserving therapy were considered as excellent and fair cosmetic results. It is concluded that the remodeling of breast following modified quadrantectomy through circumareolar skin incision is useful for preventing breast deformity.

A Case of Acardiac Twin / 대한산부인과학회잡지

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. This condition is characterized by the absence or rudimentary development of fetal heart, and associated with various anomaly. The presence of an acardiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. The acardiac malformations are uniformly fatal in the affected twin, and mortality in the co-twin is as high as 55%. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We recently experienced a case of acardius anceps associated with a normal male infant, so present with a brief review of the literature.

A Case of Kawasaki Disease Diagnosed with the Assistance of Ophthalmologic Examination

Kawasaki disease is a systemic vasculitis in which bilateral nonexudative conjunctivitis and anterior uveitis are common early findings in the course of illness. We report an eleven-year-old boy with atypical Kawasaki disease who was diagnosed with the help of an ophthalmologic examination. The patient presented with fever, epigastric pain with vomiting, erythematous rash, and severe bilateral conjunctival injection, a red throat without strawberry tongue and scarletiniform rash on the chest and back. Cervical lymphadenopathy and changes in the extremities were not shown. Slit lamp biomicroscopic examination three days after admission revealed bilateral bulbar conjuctival injection, superficial punctate erosions, and aquous humor inflammatory reaction(3+/4+ cells and 2+/4+ flare), a manifestation of anterior uveitis. After receiving two consecutive doses of intravenous immunoglobulin(IVIG, total 2.4g/kg) the boy showed no response. He was subsequently treated with high dose methylprednisolone(14mg/kg) intravenously. Two-dimensional echocardiography 2 weeks after admission showed aneurysmal changes on the proximal parts of the left main coronary artery(4.5mm) and right coronary artery(4.0mm). Slit lamp examination early in the course of the illness can help in the diagnosis of Kawasaki disease.

A Case of Cyclopia Associated with Trisomy 13 / 대한산부인과학회잡지

Cyclopia is rare congenital craniofacial anomaly, in which the eyes are fused together and located in a single orbit. It is consistently associated with severe holoprosencephaly, which is the failure of cleavage of the prosencephalon with a deficit in the midline facial development. chromosomal study revealed 47, X( ), +13 (Patau syndrome).

The Significance of Micrometastases in Axillary Lymph Node Negative Breast Cancer

BACKGROUND: Once the diagnosis of operable breast cancer has been made, the single most predictive factor is lymph node status. Although patients with lymph node initially reported as histologically negative have a relatively good prognosis, the relapse rate is still considerable. In an effort to detect micrometastases in the axillary nodes, various antibodies have been used that recognize membrane and cytokeratin antigens. Cytokeratin antigens are expressed by epithelial tumors and are not expressed by normal lymphoid tissues. This study uses an immunohistochemical method to examine the incidence and the prognostic significance of such micrometastases in a series of patients with "node-negative" breast cancer. METHODS: The study population consisted of a retrospective series of 150 patient who were treated at Soonchunhyang University Hospital for breast cancer between March 1992 and February 1998. Based on the original pathologic examination, patients had negative axillary nodes. Pan-cytokeratin, a cocktail of monoclonal antibodies to cytokeratin (58 kd, 56 kd, 52 kd, 45 kd), and the avidin-biotin-peroxidase- complex technique were used to detect micrometastases in paraffin embedded lymph nodes. RESULTS: Micrometastases were detected in 16 (10.7%) patients. The recurrence rate for patients with micrometastases was 6.3% (1/16), and the recurrence rate for patients without micrometastases was 1.5% (2/134). Micrometastases correlated with the histological type (P=0.026) and were seen more frequently with larger tumor size, higher anaplastic nuclear grade, and overexpression of p53.

A Case of Membranous Nephropathy Improved by Removal of Early Gastric Cancer / 대한신장학회잡지

The nephrotic syndrome in association with extrarenal malignancy is not an uncommon event. The membranous nephropathy is most frequently associated with various carcinomas of the lung, breast, stomach and colon. Though the exact causal relationship has not been determined completely, deposition of the immune complexes composed of antitumor antibody and tumor antigens in the subepithelium is most favorably accepted. We experienced a patient with previously diagnosed membranous nephropathy and subsequently demonstrated early gastric cancer during patient follow-up. After surgical resection proteinuria improved significantly. All physicians are strongly recommended to examine thoroughly and search carefully for possibility of concomitant occult malignancy when an aged patient, especially over 40 years old, is diagnosed as a nephrotic syndrome.

CT and MRI Findings of Intraventricular Neurocytoma

PURPOSE: Intraventricular neurocytoma, a recently recognized benign primary cerebral tumor of young adults, can be confused with oligodendroglioma and other neoplasms. The purpose of this paper is to describe the characteristic CT and MR imaging findings of intraventricular neurocytoma. MATERIALS AND METHODS: CT and MR imaging findings of five patients (M:F=2:3, ages 17-64, mean age 41) with intraventricular neurocytoma were retrospectively reviewed. All patients underwent CT scan and cerebral angiography. In four patients, MR imaging was performed and axial, sagittal, and coronal T1- and T2-weighted spin echo and gadolinium enhanced images were obtained. We evaluated the tumors with regard to location, size, shape, CT density, MR intensity, enhancement pattern, and internal texture such as calcification and cystic changes. RESULTS: All tumors were located in the lateral ventricles; especially around the foramen of monro (four cases). Their size varied from 1.0 x 1.5 cm to 4.0 x 3.0 cm and all showed a lobulated appearance. On precontrast CT scan, all tumors showed heterogeneous density due to multiple intratumoral calcifications and cystic changes. MR imaging showed a heterogeneous signal with iso- or slight hyperintensity on T1-weighted and hyperintensity on T2-weighted image, relative to cerebral parenchyme. After contrast injection, varying degrees of enhancement were noted on both CT and MR images. CONCLUSION: An intraventricular mass with or without calcification and cystic changes in the anterior portion of the lateral ventricle is suggestive of intraventricular neurocytoma. MR imaging is better in defining the exact location and cystic changes of the tumor, whereas CT is better for the characterization of calcifications.