Warfarin Induced Skin Necrosis

Warfarin is widely used for the prevention of cerebral infarction, especially in patients with atrial fibrillation or artificial valve. Although hemorrhagic problems are well known, skin necrosis is a rare complication. Failures of early diagnosis or management may lead to serious results. We report a case of skin necrosis induced by warfarin therapy.

A Case of Central Pontine Myelinolysis Associated with Hypokalemia in Hyperemesis Gravidarum

No abstract available.

Effects of Tamoxifen on the Voltage-dependent Ionic Currents in Mouse Colonic Smooth Muscle Cells / 대한소화기학회지

BACKGROUND/AIMS: Tamoxifen is a widely used anticancer drug for breast cancer with frequent gastrointestinal side effects. Changes in gastrointestinal motility is associated with altered activities of membrane ion channels. Ion channels have important role in regulating membrane potential and cell excitability. This study was performed to investigate the effects of tamoxifen on the membrane ionic currents in colonic smooth muscle cells. METHODS: Murine colonic smooth muscle cells were isolated from the proximal colon using collagenase, and the membrane currents were recorded using a whole-cell patch clamp technique. RESULTS: Two types of voltage-dependent K+ currents were recorded (A-type and delayed rectifier K+ currents). Tamoxifen inhibited both types of voltage-dependent K+ currents in a dose-dependent manner. However, tamoxifen did not change the half-inactivation potential and the recovery time of voltage-dependent K+ currents. Chelerythrine, a protein kinase C inhibitor or phorbol 12, 13-dibutyrate, a protein kinase C activator did not affect the voltage-dependent K+ currents. Guanosine 5'-O-(2-thio-diphosphate) did not affect the tamoxifen-induced inhibition of voltage-dependent K+ currents. Tamoxifen inhibited voltage-dependent Ca2+ currents completely in whole-test ranges. CONCLUSIONS: These results suggest that tamoxifen can alter various membrane ionic currents in smooth muscle cells and cause some adverse effects on the gastrointestinal motility.

Two Cases of Cervical Dystonia in Tuberculous Meningitis

Secondary cervical dystonia caused by tuberculous meningitis is extremely rare. Sixteen year-old female and 56 year-old male were admitted with fever, headache and mental change. Several days after admission they presented neck deviation and polygraphic study revealed prolonged muscular contraction of sterocleidomastoid and trapezius muscles without EEG changes. Their MRI revealed bilateral lesions in the basal ganglia. Recognition of dyskinesias associated with meningitis may be helpful in the diagnosis of tuberculous meningitis.

The Measurement of Bone Mineral Density in Parkinson's Disease

BACKGROUND: Osteoporosis, one of the most common metabolic bone disease, might be influenced by the severity of Parkinson's disease (PD). Objectives : We investigated the relationship between the Bone Mineral Density (BMD) and the severity of PD in postmenopausal and senile women. METHODS: We measured BMD of lumbar spine (L1-L4) by Dual energy X-ray absorptiometry (DEXA; Hologic QDR-4500A). We compared BMD between patient group (30 patients with PD) and control (183 postmenopausal and senile health women). The patients were divided into two groups according to osteoporosis and analyzed the following potential factors influencing BMD in PD; age, duration of symptom, age of onset, Hoehn and Yahr stage (H-Y stage), UPDRS motor score, duration of treatment, body mass index (BMI), dominant symptom such as tremor or rigidity. RESULTS: 1. BMD was significantly decreased with aging (p 0.05). CONCLUSION: Osteoporosis is related to H-Y stage, UPDRS motor score and BMI as well as aging in PD.

A Case of Horizontal Canal Benign Paroxysmal Positional Vertigo

We report the clinical features in one patients with episodic positional vertigo and apogeotropic direction changing horizontal positional nystagmus that does not fatigue, beating to the right with the head turned to the left and beating to the left with the head turned to the right. This syndrome probably represents a horizontal semicircular canal variant of benign positional vertigo. Free-floating debris and Cupula attached debris in one horizontal semicircular canal may explain many of the clinical and oculographic findings.

The Longterm Prognostic Factors After Acute Cerebral Infartion

BACKGROUND & OBJECTIVES: There are few reports of affecting factors of the longterm prognosis after acute ischemic stroke. The aim of this prospective study was to determine which variables, of those easily measurable during the first 24 hours after stroke onset, would be predictors of longterm outcome. METHOD: Ninety-eight patients with an acute ischemic stroke were evaluated within 24 hours after symptom onset. The following potential affecting factors of outcome were prospectively collected : demographic datas, socioeconomic factors, risk factors of cerebrovascular accidents, clinical f indings as measured by the National Institute of Health (NIH) scale, laboratory findings and premorbid varibles rated according to modified Rankin score (mRS). We evaluated the outcome, assessed with mRS as good (mRS 3 or less) and poor (mRS 4, 5 or death) and follow up was undertaken at 6, 12, 18 and 24 months after onset. The statistical analysis was performed by means of SPSS/PC+package to determine the longterm prognostic factors. RESULTS: The multiple stepwise regression analysis revealed that the outcome depend on NIH scale(p<0.001), age (p<0.01), previous stroke(p<0.01), loss of consciousness (LOC) at onset (p

Two Cases of Stimulus Sensitive Spinal Myoclonus

Myoclouns is a complicated and poorly-understood phenomenon caused by many pathological conditions. Myoclonus which is triggered by sensory stimuli has been termed reflx myoclonus and divided into cortical, reticular and spinal types depending on the generator sites. Segmental myoclonus of spinal origin consists of synchronous rhythmical jerks confined to a group of muscles supplied by either one segment or several contiguous segments of the spinal cords. We present two cases of spinal reflex myoclonus. One was 50 years old female who showed complex myoclonic jerks involving the abdominal wall and paraspinal muscibs resembling 'belly dance'. The other was 26 years old male who showed intermittent synchronous upper cervical axial muscle contractions. In both cases, jerks were increased with certain stimuli, but disappeared during sleep. They showed normal EEGs and absence of enhancement of SSEPS.

A Study on the Prevalence of Dementia and its Related Factors in the Rural Elderly

For the purpose of investigation of prevalence, etiology and its related factors of the dementia in the rural elderly, the author examined 650 elderly people aged 60 years or more via cluster sampling by using a door to door 2 phase design from June 1992 to July 1992. The cognitive impairment was assessed by MMSEK in the first screening phase, and in the second phase 252 people in the dementia suspected group (MMSEK score 24) were taken to the clinical examination for the diagnosing dementia. The results were as follows; 1. The prevalence rate of dementia was 21.3% in the rural elderly, and was higher in females (31.1%) than in males (10.7%) (p<0.01). 2. The prevalence rates of dementia in males aged 60-69, 70-79 and over 80 were 4.1%, 16.7% and 50.0% respectively and those in female were 8.7%, 49.3%, 72.2% respectively. The rates increased significantly with increasing age in both sexes (p<0.01). 3. The prevalence rates of the mild, moderate and severe dementia were 8.4%, 9.3% and 3.6% respectively and increased significantly with increasing age in females (p<0.001). 4. The proportional distribution of dementia type by etiological classification was 63.6% senile dementia of Alzheimer's type, 17.7% vascular dementia, 10.4% mixed dementia, 4.2% alcoholic dementia, 1.0% posttraumatic dementia and 3.1% for others. 5. In multiple logistic regression analysis for affecting factors of the dementia, the significant variables were level of physical activity, age, education and sex. The Odds ratios in factors were low level of physical activity 6.0 x (95% CI 2.4-15.1), age over 70 4.8 x (95% CI 2.2-10.7), no formal education 3.9 x (95% CI 1.1-13.8), and female sex 2.2 x (95% CI 1.0-5.0).

Intravenous Immunoglobulin Therapy in Guillain-Barre Syndrome

High dose intravenous immunoglobulin (IVIg) therapy can improve the clinical course of several immune mediciated diseases. We evaluated clinical effects and side effects of IVIg in Guillain-Barre syndrome (GBS). 19 Patients with GBS were studied prospectively in a placebo-controlled trial. 11 Patients were received high dose IVIg (400mg/kg for 5 days) and controls received only conservative treatment. The disability scores using modified Rankin scores before and after treatment of each group were compared. Four weaks later, mean Rankin Score of IVIg group was 2.5 + 0.7 and control group was 3.3+ 0.5which showed significant difference(p<0.05). There were no serious advers effer of promote early improvement with safety in acute phase of Guillan-Barre syndrome.

Brainstem Encephalitis Mimicking Miller Fisher Syndrome

We report a 18 years old man of brainstem encephalitis with acute ataxia, areflexia and gaze evoked vertical and horizontal nystagmus which is mimicking Miller Fisher syndrome. He had evidences of both peripheral neuropathy in nerve conduction studies and a brainstem encephalitis in MR findings. The possible relationship of the Miller Fisher syndrome and brainstem encephalitis are discussed with brief review of literature.