RESUMO
Valproate is one of the most popular conventional anti-epileptic drugs. It has many side effects and in rare cases, it may result in the development of parkinsonian syndromes. The parkinsonism with valproate shows insidious onset and reversible symptoms after drug withdrawal. We observed a 69-year-old woman with resting tremor, bradykinesia, cog-wheel rigidity after 2 months of valproate use. She had been suffering from epilepsy for 30 years. Her seizures were well controlled with valproate, but parkinsonian symptoms slowly progressed with doses of 1200 mg/day of valproate. After 4 months, we discontinued the doses of valproate which led to subjective and objective improvement of the parkinsonian features. The mechanism of this side effect is not well established, but GABAergic neurotransmission or mitochondrial respiratory chain may possibly be related.
Assuntos
Idoso , Feminino , Humanos , Transporte de Elétrons , Epilepsia , Hipocinesia , Transtornos Parkinsonianos , Convulsões , Transmissão Sináptica , Tremor , Ácido ValproicoRESUMO
BACKGROUND: Hemifacial spasm (HS) has been attributed frequently to vascular compression of facial nerve root exit zone from brainstem. A recent brain CT scan study showed that patients with HS had narrower posterior fossa than normal controls. However, cause relationship between narrowed posterior fossa and vascular tortuosity is unknown. METHODS: In 25 patients with HS and 29 controls, using temporal bone MRI, we measured petrous angle (PA) and pons diameter index (PDI) to define correlation between severity of posterior fossa narrowing and compression to brainstem. We compared severity of narrowing of posterior fossa between patients with and without tortuous arteries in posterior fossa. We also compared degree of narrowing of posterior fossa and clinical severity of HS. RESULTS: The mean (+/-standard deviation) of PA of 24 patients with HS (115.5 +/-6.0 degree) was significantly smaller than that of controls ( 118.6 +/- 4.8 degree). The mean (+/-standard deviation) of PDI of patients with HS (82.5 +/-4.7%) was significantly greater than that of controls (77.3 +/-3.7%). However, there was no correlation between PA and PDI in patients with HS. There was no correlation between degree of narrowing of posterior fossa and clinical severity of HS. CONCLUSIONS: Patients with HS have narrower posterior fossa as compared with controls. However, narrow posterior fossa does not seem to be a single important factor causing deformity of brainstem or tortuous arteries in posterior fossa.
Assuntos
Humanos , Artérias , Encéfalo , Tronco Encefálico , Anormalidades Congênitas , Fossa Craniana Posterior , Nervo Facial , Espasmo Hemifacial , Imageamento por Ressonância Magnética , Ponte , Osso Temporal , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND OBJECTIVES: Subacute necrotizing lymphadenitis or Kikuchi's disease is a self-limiting process of uncertain etiology that predominantly affects young women aged 20-30 years. Epstein-Barr virus (EBV), human herpesvirus-6 and toxoplasma have been suggested as potential etiologic agents. Even though this disease is self-limited, benign process, many cases are misidentified as malignant lymphoma. The purpose of this study is to report the clinicopathologic finding, radiologic finding and many laboratory tests and to elaborate the criteria that are useful in distinguishing this entity from lymphoma. MATERIALS AND METHODS: Authors evaluated 24 patients, who were diagnosed as subacute necrotizing lymphadenitis on excisional biopsy or fine needle aspiration cytology with retrospective chart review. RESULTS: The most common symptoms were cervical lymphadenopathy (96%), fever (76%) and cervical tenderness (72%). The most common site of the involvement of cervical lymph node were the upper, middle jugular and spinal accessary chains. The bilateral involvement of cervical lymph node was 69% and unilateral involvement was 31%. Microscopically, the characteristic finding was the wide area of florid nuclear dusts engulfed by histiocytes or distributed extracellularly and absence of polymorphonuclear leukocytes and plasma cells. CONCLUSION: This disease may be easily mistaken for malignant lymphoma clinically, pathologically, radiologically. So we should consider open biopsy of lymph node in the patients which had localized cervical adenopathy associated with fever and night sweat and all of which were unresponsive to antibiotic therapy, especially in young women.
Assuntos
Feminino , Humanos , Biópsia , Biópsia por Agulha Fina , Poeira , Febre , Herpesvirus Humano 4 , Histiócitos , Linfadenite Histiocítica Necrosante , Linfonodos , Linfadenite , Doenças Linfáticas , Linfoma , Neutrófilos , Plasmócitos , Estudos Retrospectivos , Suor , ToxoplasmaRESUMO
Telomerase is a ribonucleoprotein polymerase which contains an integral RNA and synthesizes TTAGGG nucleotide repeats at the ends of chromosomes in vertebrates. Accumulated evidence has indicated that telomerase is stringently repressed in normal human somatic tissues but reactivated in immortal and cancer cells, suggesting that activation of telomerase may play an important role in carcinogenesis. In order to assess the role of telomerase in the development of thyroid cancer, we measured the telomerase activity in 19 frozen samples obtained from patients with benign and malignant thyroid nodules by employing a recently developed sensitive PCR-based telomerase assay (telomeric repeat amplification protocol: TRAP). Telomerase activity was detected in all the thyroid cancer tissues (9 of 9) and 4 out of 8 benign thyroid nodules showed telomerase activity. Three of thyroid cancers with high telomerase activity had an unfavorable prognosis, whereas six cancers with low telomerase activity were associated with a favorable prognosis. interestingly, Hashimoto's thyroiditis tissues also showed telomerase activity. These results indicate that telomerase may play a key role during thyroid carcinogenesis.
Assuntos
Humanos , Carcinogênese , Reação em Cadeia da Polimerase , Prognóstico , Ribonucleoproteínas , RNA , Telomerase , Glândula Tireoide , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Tireoidite , VertebradosRESUMO
BACKGROUND: Improved intranasal visualization with endoscope allowed easy identification and opening of the lacrimal sac, without need for skin incision. OBJECTIVES: We studied and described the endoscopic dacryocystorhinostomy which has success rates comparable to those obtained by external approach. MATERIALS AND METHODS: Endoscopic dacrycystorhinostomy has been used for the treatment of nasolacrimal duct obstruction in 17 patients. The nasolacrimal apparatus related to the lateral nasal wall was approached using endoscopic technique. And bicanalicular nasal silicone tubes were placed during surgery in all cases. RESULTS: In our cases, it appears that lacrimal obstruction is related with congenital, idiopathic, facial trauma and other nasal or paranasal sinus diseases. Epiphora was relieved in 15 patients (88.2%), with a followup of 6 to 9 months. The causes of failure were granulation formation and obstruction of opening of lacrimal sac in 2 patients. CONCLUSION: Endoscopic dacryocystorhinostomy appear to be a safe and effective procedure which should be considered as an alternative to external dacryocystorhinostomy for the surgical treatment of nasolacrimal duct obstruction.
Assuntos
Humanos , Dacriocistorinostomia , Endoscópios , Seguimentos , Doenças do Aparelho Lacrimal , Ducto Nasolacrimal , Doenças dos Seios Paranasais , Silicones , PeleRESUMO
Cholesteatoma is composed of hyperproliferative keratinizing epithelium in the middle ear cavity. Its pathogenesis of destruction is not clear, and thus many theories such as pressure effect of cholesteatoma, enzymatic destruction from monocyte, cytokines including interleukin, tumor necrosis factor, and etc, are reported. Recently, several cytokines, tumor necrosis factor-alpha(TNF-alpha) and beta(TNF-beta), epithelial growth factor(EGF), transforming growth factor-beta(TGF-beta), interleukin-1(IL-1) and 6(IL-6), were immunolocalized in cholesteatoma. Of these, overexpression of EGF, TNF-alpha, IL-1 and 6 in cholesteatoma tissue have been suggested to correlate with bony destruction, but TGF-beta has been hypothesized to correlate with osteoclast inhibitory function. Here, to examine the potential role of TGF-beta in the pathogenesis of cholesteatoma and its bone destruction, I investigated gene expression in cholesteatoma tissue as well as in the normal postaural skin using RT-PCR(reverse transcription-polymerase chain reaction) technique, and obtained the following results. 1) In 13 cases of cholesteatoma, TGF-beta1 band was expressed at 474bp size marker site in 12 cases, while in 13 cases of normal postaural skin it expressed in 8 cases. 2) All of 12 cases which were expressed TGF-beta1 had granulation tissue and in 9 cases, there were bone destruction, but there was no granulation tissue and bone destruction in one case which was not espressed TGF-beta1. 3) In all cases of over 1 year disease history, TGF-beta1 expression were noted. However, in cases of under 1 year disease history, there was no expression. In conclusion, the higher expression of TGF-beta1 in cholesteatoma than normal postaural skin suggest that TGF-beta1 plays a major role in proliferation and growth of cholesteatoma as well as protective effect for bone destruction by cholesteatoma. But quantative test will be needed to clarify this point.
Assuntos
Colesteatoma , Citocinas , Orelha Média , Fator de Crescimento Epidérmico , Epitélio , Expressão Gênica , Tecido de Granulação , Interleucina-1 , Interleucinas , Monócitos , Necrose , Osteoclastos , RNA Mensageiro , Pele , Fator de Crescimento Transformador beta , Fator de Crescimento Transformador beta1 , Fator de Necrose Tumoral alfaRESUMO
No abstract available.
Assuntos
Hipersensibilidade , Imunoglobulinas , Otite Média com Derrame , Otite Média , OtiteRESUMO
We have reported a case of granular cell myoblastoma of the larynx which is considered to the first reported case in the Orient. A review of the literature is given with special emphasis on the pathology, various theories of histogenesis, diagnosis, treatment and prognosis.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Povo Asiático , Coreia (Geográfico) , Neoplasias Laríngeas , Neoplasias de Tecido MuscularRESUMO
The authors examined 312 outpatients, including 100 with otorrhea, 144 with rhinorrhea and 68 with pharyngeal discharge. The pH of otorrhea was generally acid, except in 2 cases of diffuse otitis externa where the discharge was strongly alkalihe. Otorrhea in purulent otitis media was mucopurulent or purulent and was strongly acid. The pH of rhinorrhea ranged from 6.6 to 7.4, being generally weakly alkaline. In acute rhinitis, it was alkaline in half the cases; a tendency to greater alkalinity showed in cases of marked swelling of the inferior nasal conchae. In chronic paranasal sinusitis, the pH generally shifted to the acid side; in acute paranasal sinusitis and in nasal polyps, it was weakly alkaline in all cases; and in allergic rhinitis it was neutral with in a narrow range. the usual pH of oral and pharyngeal discharges ranged from 6.4 to 7.0, being generally weakly alkaline. The character of inflammatory discharges was serous or mucous in all cases, except for a case of peritonsillar abscess with mucopurulent discharge; the pH was weakly alkaline in 5 cases (7.4 per cent), neutral in 26 (38.2 per cent), and acid in 37 (54.4 per cent). When these discharges changed in character from seromucous to purulent, their pH was lowered.