The Pattern of Cognitive Impairment Associated with the Motor Subtype in Parkinson's Disease

BACKGROUND: Previous studies have found over-representation of a postural instability and gait difficulty(PIGD) motor subtype in Parkinsons disease with dementia(PD-D). METHODS: One hundred twenty patients with Parkinson's disease(PD) were included in this study. All patients were evaluated by the Unified Parkinson's Disease Rating Scale(UPDRS) and neuropsychological tests. On the basis of the criteria for dementia(DSM-IV) and the results of the neuropsychological assessments, the patients were divided into the following three groups: (1) non-demented(PD-ND), (2) mild cognitive impairment(PD-MCI), and (3) dementia (PD-D). In addition, patients were also grouped into the following two phenotypes based on the UPDRS components: (1) tremor and (2) postural instability gait difficulty(PIGD)-predominant. We also analyzed the clinical characteristics and subtypes of the disease. In addition, the relationship between the cognitive impairments and the parkinsonian motor handicaps was evaluated. RESULTS: There was a significant relationship between cognitive impairment and the motor subtypes. The PIGD group had a higher prevalence of PD-D than the other group. In addition, there were significant correlations between the general cognitive functions and motor handicaps, especially those with axial symptoms. Multiple logistic regression analysis showed that the motor subtype was independently associated with the cognitive decline in PD. CONCLUSION: These findings support that cognitive decline in patients with PD is associated with a specific motor subtype. This association might be explained by the involvement of non-dopaminergic pathways. These results have implications for the clinical management of PD with regard to the motor symptoms and cognition.

Two Cases with Carbamazepine-induced Unusual Side Effects-Encephalopathy and Myoclonic Jerks

Central nervous system toxicity is the most commonly recognized problem during treatment with carbamazepine (CBZ). The most common side effects of CBZ are drowsiness, incoordination, and vertigo. However, unusual conditions such as movement disorders, seizure aggravation, and encephalopathy have also been attributed to CBZ therapy. In case 1, cognitive dysfunction and exacerbation of preexisting gait disturbance were observed in a 63-year-old female who had frontal lobe epilepsy, schizencephaly, and lissencephaly treated with CBZ. The neurological symptoms were resolved 24 hours after the withdrawal of CBZ and induced with the reintroduction of CBZ. In case 2, myoclonic jerks occurred in a 37-year-old female when CBZ was readministered after a 4-day-withdrawal period of CBZ. The myoclonic jerks disappeared 12 days after CBZ was discontinued. In both cases, plasma CBZ levels were within the therapeutic range. We report two cases with encephalopathy and myoclonic jerks as unusual side effects of CBZ, with the plasma levels of CBZ being within the therapeutic range.

Transient Cortical Blindness after Removal of Subclavian Vein Catheter

A 42-year-old woman who had undergo a subtotal gastrectomy for stomach cancer, developed transient bilateral cortical blindness and hemiplegia after the removal of a subclavian vein catheter. A brain MRI, transcranial doppler sonogram and visual evoked potentials revealed no abnormalities. She returned to normal neurologic status 4 days after onset. There have been a few cases of transient cortical blindness after an insertion or removal of the subclavian vein catheter. However, caution should be taken for this possibility whenever the subclavian catheter is inserted or removed.

A Case of Colonic Angiodysplasia in Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Colonic angiodysplasia is important because of the likelihood of lower gastrointestinal tract bleeding, either massively or chronically. A 66-year-old male patient visited our hospital because of hematochezia and lower abdominal discomfort. He underwent colonoscopy, which revealed 0.5 cm sized, cherry red colored, branching, ozzing vessel with fern-like margin on cecum. Although he received endoscopic injection therapy with hypertonic saline and oral estrogen-progesterone therapy, subsequent ileocecal resection was performed due to recurrent bleeding. Histology of the resected specimen showed irregularly dilated, distorted, thin-walled vessels in submucosa.

A Case of Bleeding Jejunal Tuberculosis Diagnosed with Intraoperative Endoscopy / 대한소화기내시경학회지

Tuberculosis is a multi-organ disease. The incidence of pulmonary tuberculosis is declining due to improvement in public health, vaccination and the development of anti-tuberculosis medication, but extrapulmonary tuberculosis has become more common, especially in immuno-compromised individuals, AIDS patients and immigrants to western worlds. Gastrointestinal tuberculosis continues to give rise to diagnostic and therapeutic challenges. The jejunal tuberculosis is uncommon and presents a difficult diagnostic problem. Bleeding jejunal tuberculosis is a very rare source of lower gastrointestinal bleeding. We have recently experienced a case of a jejunal tuberculosis which was proven to be a source of gastrointestinal bleeding by intraoperative endoscopy and was confirmed by surgical exploration. This report summarized our experience and review of literature.

A Case of Anti-Glomerular Basement Membrane Antibody Associated Crescentic Glomerulonephritis with Positive Antineutrophilic Cytoplasmic Antibody / 대한신장학회잡지

A 63-year-old woman presented to the hospital with gross hematuria and acute renal failure. Kidney function deteriorated rapidly and progressively. A renal biopsy revealed segmental or circumferential crescents associated with linear deposits of immunoglobulin G, typical of anti-glomerular basement membrane disease. Both c-ANCA and anti-GBM antibody were detected in serum. She was treated with hemodialysis, plasmapheresis, high dose steroid and cyclophosphamide. However, she died 7 weeks after treatment because of pneumonia, without recovery of renal function. Serologic positivity of both ANCA and anti-GBM antibody are becoming more frequently recognized in rapidly progressive glomerulonephritis. The influence of c-ANCA on the clinical course of anti-GBM glomerulonephritis remains to be determined.

A case of Primary Hemangiopericytoma of the Lung / 결핵

Primary hemangiopericytomas of the lung are uncommon sarcomas that arise from pericytes that surround the basement membrane of capillaries and small venules within the lung parenchyma. The presenting symptoms and signs depend on the location of the tumor and radiologic features are not diagnostic. The behavior of pulmonary hemangiopericytomas is difficult to predict and all tumors should be considered potentially malignant. Wide surgical excision remains the mainstay of treatment. We report a case of primary hemangiopericytoma of the lung with a brief review of literature.

Two Cases of Sporadic Encephalitis Lethargica

We present two patients with clinical features suggestive of a hyperkinetic form of encephalitis lethargica described by von Economo. While undergoing treatment for viral meningoencephalitis, they both developed comatose mentality, oromandibular dyskinesia, chorea, myoclonic jerk, oculogyric crisis, opistotonus, respiratory failure, and autonomic dysfunction. One patient died of autonomic failure while the other improved several months later. In both patients, cerebrospinal fluid exmamination revealed only pleocytosis. A brain MRI and EEG showed no specific findings. In order to control severe hyperkinetism and autonomic failure, medical treatments including L-dopa, clonazepam, and steroid pulse therapy were administereed in both cases while electroconvulsive therapy was tried in one of the cases. However, they all failed. These cases and previous reports informed us of the presence of sporadic form of encephalis.

The relationship of psychotropics use to TRH stimulation test in depressed patients and schizophrenic patients / 신경정신의학

No abstract available.

The relationship of sex to TRH stimulation test in bipolar patients and schizophrenics / 신경정신의학

No abstract available.

Total anomalous pulmonary venous return(infradiaphragmatic type)

The infradiaphragmatic type of Total Anomalous Pulmonary Venous Return(TAPVR) is a rare congenital cardiacanomaly which usually results in death during the period of early infancy. A two month-old baby boy with cyanosisand respiratory distress was suspected of having a TAPVR clinically and the two-dimensional echocardiographicfindings were compatible with the infradiaphragmetic type of TAPVR. The subsequent cardiac catheterization andcineangiogram revealed the common pulmonary vein connected with portal vein and inferior vena cava in theinfradiaphragmetic area with obvious obstruction. The surgery and the autopsy confiremd the preopeative diagnosis.Among infants presenting pulmonary venous congestion in the newborn period. TAPVR below the diaphragm shold be oneof the important diagnostic cosiderations.

Clinical Studies on Neonatal Jaundice and Exchange Transfusion

No abstract available.

Animal Experiment of Domestic Dynamic Compression Plate / 대한정형외과학회잡지

Dynamic compression plate, used in the orthopedic surgery as internal fixation system, should have excellent biocompatibility, corrosion resistance, and adequate mechanical properties. The object of this research was test of its biocompatibility as compared with Osteo DCP and fabnfication of a KAIST" DCP with evaluation of its effect by animal experiment. The conclusions were follows: 1. The corrosion resistance of domestic DCP had no significant difference as compared with foreign made DCP. 2. The tissue responses to DCP were thought to be adequate. 3. The new-design DCP had less mobility at fracture site as compared with existing DCP, but there was no significant statistical differences. 4. In summary, it was concluded that KAIST DCP could be applied to the human body and it would be worth while to research the advantages of new-design DCP. DCP: Dynamic Compression Plate KAIST: Korea Advanced Institute of Science & Technology.

An Animal Experiment for Domestic Production of Metallic Implant / 대한정형외과학회잡지

In Korea, the metallic implant had to be supplied through import channel with many problems. KAIST succeeded in making AISI 316 LVM stainless steel within the criteria of American Society for Testing and Materials. With the animal experiment at preliminary report I, the biocompatibility in the muscle was examined. For biocompatibility test of new material, test in the bone is essential. In this animal experiment using rat tibia, the biocompatibility of the Kirschner wire of KAIST was compared with that of Zimmer. The result was as follows: 1. Tissue reaction of the Kirschner wire of KAIST was minimal to moderate. 2. Corrosion was negligible, and there was no definite difference between the KAIST and Zimmer Kirschner wires. 3. Authors observed the satisfactory biocompatibility of the KAIST Kirschner wite in bone and muscle, and concluded that the Kirschner wire of KAIST can be applied to human body without serious problems.