5-Fluorouracil-induced leukoencephalopathy in patients with breast cancer

The purpose of this study is to determine the characteristic clinical features, radiologic findings, and precipitating and prognostic factors in the patients with breast cancer and with 5-Fluorouracil (5-FU)-induced leukoencephalopathy. We reviewed the medical records of six breast cancer patients who developed leukoencephalopathy after chemotherapy which included 5-FU and also evaluated thorough neurological examinations including mini-mental status examination, cerebrospinal fluid studies, brain images and brain biopsies. Six patients exhibited slowly progressing neurologic symptoms characterized by the impairment of cognitive function, abulia, ataxic gait, and/or akinetic mutism. None of the patients had any specific causes or etiologic factors for leukoencephalopathy. Brain MRI in all patients showed diffuse periventricular white matter changes in the T2-weighted MR image. Brain biopsy in Patient 1 showed fragmented axonal fiber and minimally deprived myelination with many scattered macrophages. Five patients who treated with steroids at the onset of neurological symptoms showed clinical improvement, regardless of their age, sex, the pathology and stage of breast cancer, or the total dosage of chemotherapeutic agents. We conclude that leukoencephalopathy in these cases could be attributable to 5-FU neurotoxicity and suggest that the administration of steroids might be the treatment of choice.

Diffusion-weighted Magnetic Resonance Image Findings in Clinically Diagnosed Creutzfeldt-Jakob Disease

We report distinctive diffusion-weighted magnetic resonance image (DWI) findings in a 65-year-old man with clinically diagnosed Creutzfeldt-Jakob disease (CJD). Four weeks before admission he developed general weakness and febrile sense which were followed by progressive dementia, ataxia, and choreo-athetoid movement of the right hand. T2-weighted magnetic resonance image (MRI) showed subtle high signal intensities only in the left basal ganglia, whereas DWI demonstrated marked hyperintensities in multiple regions including the left basal ganglia and left cerebral cortex. Five weeks after the onset of symptoms, he was noted to have myoclonus and characteristic electroencephalographic changes consisting of periodic triphasic sharp waves. In our patient, high signal changes on the DWI preceded myoclonus and typical EEG findings, a result suggesting that DWI may be useful in the early premortem diagnosis of CJD.

A case of de novo B - cell prolymphocytic leukemia associated with false - positive direct antiglobulin test / 대한내과학회지

De novo B-cell prolymphocytic leukemia (B-PLL) is a distinct clinicopathologic entity that was first described in 1974 by Galton et al. B-PLL is characterized by marked lymphocytosis with predominance of prolymphocytes, often massive splenomegaly, minimal lymphadenopathy, often aggressive clinical course and frequently poor prognosis.We experienced a case of B-PLL associated with false-positive direct antiglobulin test. The patient was 52 year-old man who presented with marked leukocytosis (160.2x103/(mu)L) and 60% of characteristic prolymphocytes in the peripheral blood. The bone marrow aspirate showed dry tap and the PAS stain of peripheral blood smear showed positivity of prolymphocytes. The immunophenotyping of the leukemic prolymphocytes revealed the positivity of surface immunoglobulin (IgM, lambda type), HLA-DR, CD19 and CD5.

Contralateral Hyperperfusion on Single Photon Emission ComputedTomograhy (SPECT) in the Patient with Todd's Paralysis

It has been known that the usual findings of SPECT in patients with Todd's paralysis is the hypoperfusion of the corresponding hemisphere. We experienced a patient who developed transient hemiparesis after a seizure attack with hyperperfusion rather than hypoperfusion over the corresponding hemisphere on brain SPECT. A 36-year-old female presented with left hemiparesis after a secondarily generalized tonic seizure. No additional seizure-like attack was noted during admission. EEG showed intermittent focal slow waves over the right frontotemporal area on admission and returned to a normal pattern 72 hours after admission. Tc-99m ECD SPECT showed hyperperfusion on the right frontoparietal area in spite of the normalization of EEG. The degree of hyperperfusion was diminished as time passed for at least 72 hours. We report a patient who had Todd's paralysis associated with contralateral frontoparietal hyperperfusion. Todd's paralysis may be explained as the result of focal discharges that lead to local vasomotor changes.

A case of autoimmune neutropenia / 대한내과학회지

Autoimmune neutropenia is characterized by severe neutropenia with cell-bound neutrophil antibodies or circulating antibodies for neutrophils. Diagnosis of disease is made of the basis of the presence of antibodies for neutrophil. Corticosteroid or rhG-CSF have been reported to be effective in some patients. Recently we experienced one case of autoimmune neutropenia patient who was admitted to our hospital in 1997 because of stomach cancer and degenerative joint disease. She had severe neutropenia without underlying autoimmune disease. And cell-bound neutrophil antibodies were detected by indirect immunofluorescence test. Treatments with rhG-CSF and steroid result in transient improvement of neutropenia and subtotal gastrectomy was done successfully. We herein report one case of autoimmune neutro- penia patient, to our best knowledge, the first report in Korea, with a brief review of literature.

The effect of Postural Changes on Pleural Fluid Constituents / 결핵

BACKGROUND: Measurement of pleural fluid constituents are of value in the diagnosis of pleural effusions and in the seperation of exudates from transudates. The position of the patient (sitting or lying) prior to thoracentesis may result in difference in the measurement of these constituents. The purpose of this study is to determine whether postural differences in pleural fluid constituents exist, and if so, whether they are of any clinical significance. METHOD: 41 patients with pleural effusions on chest roentgenography were prospectively studied. The fluid cell counts, partial gas tension, and concentrations of chemical constituents were compared in the supine and upright positions. RESULTS: 1) A total of 10 patients were found to have an transudative effusion. In the transudates there was no significant difference in pleural fluid constituents according to posture change. 2) A total of 31 patients were found to have an exudative effusion. Statistically significant postural changes were noted in pH, WBC counts, protein, and LDH concentrations in the exudates. It may be due to postural sedimentary effect in the pleural space. 3) The PC02 measurements and glucose concentration were not affected by changes in position in exudates or transudates. CONCLUSION: Postural sedimentary effect occurs in the pleural space with reference to the measurement of certain pleural fluid constituents when an inflammatory process is present. Therefore it is recommended that thoracentesis after 30 minutes in the sitting position should be performed.

Clinical study of adult-onset minimal change neohrotic syndrome / 대한신장학회잡지

No abstract available.

Distal renal tubular acidosis in sjogren syndrome with rheumatoid arthritis / 대한신장학회잡지

No abstract available.