Freezing of Gait in Extrapontine Myelinolysis

A 65-year-old female visited us due to gait disturbance. A neurological examination showed cognitive impairment, dystonia, myoclonus, bradykinesia, postural instability, and freezing of gait (FOG). She was diagnosed with extrapontine myelinolysis based on her history of hyponatremia and high signal intensities (HSIs) in both striata on T2-weighted images. Her neurological problems including FOG improved over 25 days. In a follow-up MRI 50 days after the onset, HSIs disappeared in the striata but new ones appeared in the pons. FOG may have been related to striatal dysfunction in this patient.

Solid Cerebellar Hemangioblastoma with Peritumoral Edema: 5-Years Follow up

Hemangioblastomas are angioblastic tumors of the central nervous system. Cerebellar hemangioblastomas are traditionally classified into two morphologic types-cystic and solid. Cystic hemangioblastomas are associated with peritumoral edema, but solid hemangioblastomas are not. We report a case of solid cerebellar hemangioblastoma with massive peritumoral edema. An 83-year-old female visited our hospital due to a sudden headache. Five years ago, she had been admitted to our hospital with similar headache and diagnosed with cerebellar hemangioblastoma. Follow-up brain MRI 5 years later showed an increased size of a homogeneous enhancing mass with aggravated peritumoral edema in the left lower cerebellar hemisphere. Cerebral angiography showed a highly vascularized mass in the cerebellum, which was compatible with a solid-type hemangioblastoma.

A Fatal Case of Full-Blown Neuro-Behcet Disease / 대한임상신경생리학회지

We reported a 48-year-old man with Behcet disease, who presented with right hemiparesis. His first brain MRI showed multiple enhanced lesions. During the recovery, he had an episode of left 6th nerve palsy without new lesions in a follow-up MRI. Third episode was cervical myelitis, resulting in respiratory difficulty and quadriplegia without any reflexes. The myelitis was not responsive to immunotherapy. He died of respiratory failure complicated with pneumonia. This is a rare case of full-blown neuro-Behcet disease.

Asymptomatic Hematoma in Herpes Simplex Encephalitis / 대한임상신경생리학회지

A 59-year old man was admitted for drowsiness and stiff neck. CSF examination showed lymphocytic pleocytosis and PCR for herpes simplex virus (HSV)-1 was positive in CSF. Brain MRI revealed enhanced lesions in left temporal lobe. His symptom improved with acyclovir. Follow-up studies showed red blood cells in CSF and a hematoma in the left temporal lobe. There was no additional symptom related to the hematoma. He was discharged after conservative care. Although rare, hematoma can develop in HSV-1 meningoencephalitis.

Effect of serum E2 levels on the pregnancy outcome of IVF-ET / 대한산부인과학회지

OBJECTIVE: To evaluate the effects of serum E2 levels on the day of hCG administration on the pregnancy outcome of IVF-ET after controlled ovarian hyperstimulation (COH). METHODS: Data of 455 cycles of fresh IVF-ET with COH were retrospectively investigated. Serum E2 levels on the day of hCG administration were categorized into 5 groups; A ( or =4,000 pg/mL). RESULTS: Mean E2 levels on the day of hCG administration were 3,745.3 pg/mL and mean number of retrieved oocytes were 10.1. Of 455 cycles, 148 (32.5%) cycles were clinically pregnant. Implantation rate was 12.2% and delivery rate was 18.7%. The number of obtained oocytes increased with increasing levels of serum E2. Pregnancy rate gradually increased as E2 levels increased up to the group D, but began to fall in the group E. In younger women ( or =38 yrs), pregnancy rate and delivery rate were significantly higher in the group C than other groups. CONCLUSIONS: This result shows that serum E2 levels have a concentration-dependent effect on the pregnancy outcome and there is an optimal range of E2 levels to achieve for a successful pregnancy. Excessive E2 levels seem more deleterious to the pregnancy outcome in older women aged > or =38 years.

Arterial Stiffness, Malnutrition and Inflammation in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: In ESRD patients, malnutrition and atherosclerosis are strongly associated with inflammation resulting in MIA (Malnutrition-Inflammation-Atherosclerosis) syndrome. As compared with atherosclerosis, arteriosclerosis or arterial stiffening is another important cardiovascular risk factor. Therefore, we speculated on the presence of new MIA syndrome, which is composed of malnutrition, inflammation and arteriosclerosis, and evaluated causal relations among them in 70 chronic hemodialysis patients (age 53+/-13 years, male 53%, diabetes 40%). METHODS: As an indicator of arterial stiffness, brachial-ankle pulse wave velocity (PWV) was measured using a plethysmography. PWV index (measured PWV/nomogram based theoretical PWV) was then calculated to adjust confounding effects of age, blood pressure, and gender by using the PWV nomogram obtained in nonuremic population with same age, blood pressure, and gender. Nutritional status was assessed by serum albumin level, subjective global assessment (SGA) and normalized protein catabolic rate (nPCR). Extracellular fluid and intracellular fluid volume ratio (ECF/ICF) were determined using bioimpedance analysis. The presence of an inflammation was assessed by serum high sensitivity C-reactive protein (CRP) level. RESULTS: PWV index correlated positively with log transformed CRP (LnCRP) level, ECF/ICF and negatively with SGA, nPCR and serum albumin level. Serum albumin level correlated positively with nPCR, BUN, hemoglobin level and negatively with LnCRP level, age and ECF/ICF. Diabetic patients had higher PWV index and lower albumin level than non-diabetic patients. In multiple regression analysis, only LnCRP level was a significant common determinant of the both PWV index (R2=0.419; p >0.001) and serum albumin level (R2=0.543; p<0.001). CONCLUSION: Increased CRP levels are independently associated with arterial stiffening and hypoalbuminemia. Inflammation might be a linking mechanism of arterial stiffening and malnutrition in chronic hemodialysis patients.

Effects of Metformin on Clomiphene-resistant Infertile Women with Polycystic Ovary Syndrome / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of metformin for ovualtion induction and pregnancy in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS). METHODS: From March 2001 to March 2002, 19 patients with PCOS who had at least two consecutive cycles of anovulation in response to CC treatment up to 250 mg/day at the Infertility Center of Moon Hwa Hospital were enrolled in this study. The participants were required to have tubal patency on hysterosalpingography and their husbands were required to have normal semen analysis. The mean age was 30.5 +/- 3.6 years, the body weight 62.7 +/- 10.1 kg, the duration of infertility 3.7 +/- 2.1 years and the BMI 24.7 +/- 3.6 kg/m2. For 19 patients, a total of 75 cycles were treated with 1) CC+gonadotropin (group 1; 24 cycles), 2) CC+metformin (group 2; 29 cycles), or 3) CC+gonadotropin+metformin (group 3; 22 cycles). As for gonadotropin, highly purified-follicle stimulating hormone (HP-FSH) or/and hMG were used from the 3rd day of CC treatment. In the first cycle, metformin (1,500 mg/day) was administered during 1-28 days of menstrual cycle. Metformin was discontinued when a pregnancy was confirmed. RESULTS: Among 19 patients, 17 patients were ovulated (89.5%) and 7 patients (36.8%) were pregnant. Of a total of 75 cycles, 51 cycles (68.0%) were ovulated successfully with one of three treatment methods. Metformin treatment had similar ovulation rate compared to gonadotropin treatment. There was no significant difference in ovulation rate among the three groups (70.8% vs 58.6% vs 63.7%). However, the pregnancy rate was significantly higher in group 3 (18.2%, 4 cycles) compared to group 1 (8.3%, 2 cycles) and group 2 (6.9%, 2 cycles). Of pregnant cycles, all 2 cycles from group 1 were spontaneously aborted. One cycle in group 2 and one cycle in group 3 were spontaneously aborted and all other pregnant cycles were normally delivered. CONCLUSION: With the combination therapy of metformin, the improvement in pregnancy rate among CC-resistant PCOS infertile women might be expected.

Learning Curve of Laparoscopic Myomectomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effectiveness and feasibility of laparoscopic myomectomy compared to open myomectomy METHODS: A retrospective study of 85 cases of myomectomy was performed. Twenty six cases of open myomectomy (group I) and 59 cases of laparoscopic myomectomy (group II) were done by one main surgeon from 1996 to 2002 in the department of OBGYN at Moonhwa Hospital. Group II was divided into two subgroups, group IIA and group IIB. Group IIA included 17 cases of laparoscopic myomectomy done from 1996 to 1998 during learning period. Group IIB included 42 cases of laparoscopic myomectomy performed from 1999 to 2002 after learning period. RESULTS: There were no significant differences in age, parity, the number of myoma, and the size of myoma between groups I and II. The intensity of postoperative pain and febrile morbidity were significantly lower in group II than in group I (P<0.05). Mean operation time was significantly shorter in group I than in group II. However, after completing the learning curve, no significant difference was found in the operation time between group I and group IIB. Blood loss was significantly decreased in group II compared to group I (P<0.05). CONCLUSION: The learning curve for lasparoscopic myomectomy needed 17 cases and laparoscopic myomectomy could be an excellent minimally invasive method as an alternative of open myomectomy after learning curve.

Study on Consequent Nutrient Intake Status, Body Mass Index, and Fat Distribution after Silk Amino Peptide and Dietary Fiber Supplementation

This study is to investigate consequent nutrient intake status, influence of body mass index(BMI), and fat distribution on the silk amino peptide(SAP) and dietary fiber supplementation. During 2 months of this research (January to March, 2002), 45 women aged 20yr - 30yr (average age 24.6yr) were selected as subjects. Nutrient intake was investigated by questionnaire, 24-hr recall method. Antropometric assessments of the subjects were investigated by SBIA method(Segmental bioimpedance assay, In body 3.0). The results are as follows : mean body weight 57.7kg, mean body height 161.9cm mean BMI 22.0, and mean food habit score was 8.47. Defecation frequency was increased by dietary fiber supplementation. Frequency of pain during defecation was significantly decreased by dietary fiber supplementation (p<0.01). Feeling of residual feces was significantly improved by dietary fiber supplementation(p<0.001). Status of energy and carbohydrate intakes significantly decreased after dietary fiber supplementation(P<0.05). Body fat and WHR(waist hip ratio) significantly decreased after dietary fiber supplementation(P<0.001), and percent body fat was decreased by dietary fiber supplementation, significantly(P<0.05). Above results of this study show that dietary fiber-added routine diet improves defecation condition, and lessens body fat, percent body fat without losing body muscle. Especially, declination of abdominal fat and WHR were notable. That meant decreased risk factor.