Concurrence of Multifocal Motor Neuropathy and Hashimoto's Thyroiditis

BACKGROUND: Multifocal motor neuropathy (MMN) is an immune-mediated disorder that is characterized by slowly progressive and asymmetrical weakness, but its pathophysiological mechanism is uncertain. The hypothesis that MMN is an immunological disease has been supported by the proven therapeutic effects of intravenous immunoglobulin and the detection of antiganglioside antibodies in MMN patients. The coexistence of MMN with other immune diseases has been rarely reported. CASE REPORT: A 37-year-old woman visited our hospital complaining of weakness in both hands. The clinical manifestations coincided well with MMN: predominantly distal upper-limb weakness, asymmetric involvement, a progressive course, absence of sensory symptoms, absence of pyramidal signs, and sparing of the cranial muscles. The electrophysiological findings also supported a diagnosis of MMN, with motor nerve conduction block in the median, ulnar, and radial nerves, without sensory nerve involvement. The patient was simultaneously diagnosed as having Hashimoto's thyroiditis, which is a well-known immune-mediated disease. CONCLUSIONS: The concurrence of MMN and Hashimoto's thyroiditis in our patient is significant for understanding the immunological characteristics of the two diseases.

Neurosarcoidosis Presenting as Spinal Nerve Root Pain of Trunk

A 60-year-old man developed severe pain and numbness around the trunk 4 months prior to admission. On examination he showed multiple cranial neuropathies. Girdle-like paresthesia and facial diplegia prompted a possible diagnosis of neurosarcoidosis. Chest computed tomography demonstrated bilateral hilar and mediastinal lymphadenopathy, and histological findings were consistent with sarcoidosis. These observations indicate that it is important to pay attention to neurosarcoidosis when patients show unknown spinal root pain, even though this is a rare condition.

128 Cases of Endoscopic Sphincterotomy (EST) / 대한소화기내시경학회지

Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.