Central Pontine Myelinolysis Induced by Alcohol Withdrawal: A Case Report

Central pontine myelinolysis (CPM) is a demyelinating disorder characterized by the loss of myelin in the center of the basis pons, and is mainly caused by the rapid correction of hyponatremia. We report the case of a young woman who presented with gait disturbance and alcohol withdrawal, and who was eventually diagnosed with CPM. Generally, the cause and pathogenesis of CPM in chronic alcoholics remain unclear. In this cases, the CPM may be unrelated to hyponatremia or its correction. However, it is possible that the osmotic pressure changes due to refeeding syndrome after alcohol withdrawal was the likely cause in this case. This case illustrates the need for avoiding hasty, and possibly incomplete diagnoses, and performing more intensive test procedures to ensure a correct diagnosis.

Change of Bone Mineral Density and Relationship to Clinical Parameters in Male Stroke Patients

OBJECTIVE: To investigate the clinical characteristics that significantly contribute to a decreased bone mineral density (BMD), the BMD changes and clinical characteristics of men who experienced a stroke between the ages of 50 years and 65 years were studied between 3 months and 4 months after the stroke. METHODS: Subjects had a brain hemorrhage or a cerebral infarction. Only men aged 50 years to 65 years were included to eliminate postmenopausal osteoporosis and to eliminate the influence of senile osteoporosis. All subjects underwent a BMD test between 3 months and 4 months after their strokes. Also, patients with a medication history that might have caused a secondary osteoporosis before a stroke were excluded. RESULTS: The BMD for the lumbar spine and hemiplegic side of the femoral neck correlated significantly with the results of the manual muscle test (MMT) of the hemiplegic lower extremity and the Modified Barthel Index (MBI) score. This result suggests that the immobility from the decreased muscle strength and the weakened daily functionality might have reduced the BMD. According to a multiple linear regression analysis, the MBI score is significantly correlated with the lumbar BMD. The BMD of the hemiplegic femoral neck is significantly correlated with the MMT and the MBI score. CONCLUSION: This study showed that BMD monitoring should be considered in male stroke patients, especially for patients with a high dependency in daily functions and a decreased muscle strength in the hemiplegic lower extremity.

Different Movement of Hyolaryngeal Structures by Various Application of Electrical Stimulation in Normal Individuals

OBJECTIVE: To identify the differences in the movement of the hyoid bone and the vocal cord with and without electrical stimulation in normal subjects. METHODS: Two-dimensional motion analysis using a videofluoroscopic swallowing study with and without electrical stimulation was performed. Surface electrical stimulation was applied during swallowing using electrodes placed at three different locations on each subject. All subjects were analyzed three times using the following electrode placements: with one pair of electrodes on the suprahyoid muscles and a second pair on the infrahyoid muscles (SI); with placement of the electrode pairs on only the infrahyoid muscles (IO); and with the electrode pairs placed vertically on the suprahyoid and infrahyoid muscles (SIV). RESULTS: The main outcomes of this study demonstrated an initial downward displacement as well as different movements of the hyoid bone with the three electrode placements used for electrical stimulation. The initial positions of the hyoid bone with the SI and IO placements resulted in an inferior and anterior displaced position. During swallowing, the hyoid bone moved in a more superior and less anterior direction, resulting in almost the same peak position compared with no electrical stimulation. CONCLUSION: These results demonstrate that electrical stimulation caused an initial depression of the hyoid bone, which had nearly the same peak position during swallowing. Electrical stimulation during swallowing was not dependent on the position of the electrode on the neck, such as on the infrahyoid or on both the suprahyoid and infrahyoid muscles.

Superior Mesenteric Artery Syndrome in Traumatic Brain Injury: A case report

Superior mesenteric artery syndrome (SMAS) is a rare cause of proximal duodenal obstruction resulting from compression of the duodenum by the SMA against the aorta. Risk factors associated with SMAS are prolonged supine position, weight loss and decreased abdominal wall muscle tone; all of which are frequently accompanied with traumatic brain injury (TBI). The following case report describes a patient who developed SMAS in the setting of TBI. This report presents a 16 year old male with TBI who had postprandial epigastric pain, vomiting and weight loss. Computed tomography and upper gastrointestinal series demonstrated the existence of SMAS. The patient was managed conservatively with total parenteral nutrition to obtain a positive nitrogen balance. Physician should consider SMAS in the differential diagnosis of patients presenting with abdominal pain and vomiting.

Teicoplanin-induced Elevation of Plasma Creatine Phosphokinase in the Patient with Wound Infection: A case report

The use of teicoplanin is increasing with increase in the incidence of wound infections caused by methicillin-resistant Staphylococcus aureus. Teicoplanin has longer half-life than vancomycin, so it can be administerd once daily, whereas vancomycin has to be administered 3~4 times daily. Teicoplanin is known to have lesser side effect profiles than vancomycin, such as skin eruptions, ototoxicity and nephrotoxicity. A 27-year old women in vegetative state had a grade 3 pressure sore at coccyx area. We prescribe teicoplanin to manage wound infected by methicillin-resistant Staphylococcus aureus. Plasma creatine phosphokinase (CPK) was elevated abruptly at 9th day of teicoplanin therapy. Five days after discontinuation of teicoplanin, CPK was normalized. We experienced a case of elevation of plasma creatine phosphokinase associated with teicoplanin.

Arnold-Chiari Type I Malformation with Hemihypertrophy: A case report

The association between Arnold-Chiari type 1 malformation and hemihypertrophy has not been appreciated but a few case reports have suggested their association and proposed a common pathogenesis of dysembryoplasia of mesoderm. We report a case of 17 year-old girl presenting with left side hemihypertrophy and scoliosis. Magnetic resonance imaging (MRI) study of brain and spine revealed underlying Arnold- Chiari type 1 malformation and syringomyelia. The purpose of this paper is to emphasize the need for central nervous system evaluation in patients with hemihypertrophy.

Comparison between Diagnostic Criteria for Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Hemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH) / 대한혈액학회지

BACKGROUND: The criteria set by the International Society on Thrombosis and Hemostasis (ISTH) with the criteria of the Korean Society on Thrombosis and Hemostasis (KSTH) for the diagnosis of DIC was compared to evaluate the agreement between two criteria and the characteristics of each criteria. METHODS: Two hundred ninety-six adult patients with sepsis (57 pneumonia, 75 hepatobiliary and gastrointestinal infection, 25 urinary tract infection, 51 infection associated with malignant diseases and 84 other causes) were studied. The rate of agreement in the diagnosis of DIC by the two diagnostic systems was analyzed. Characteristics of each criteria was also analyzed by the comparison of laboratory criteria. RESULTS: The kappa coefficient and concordance rate, agreement parameters in the diagnosis of DIC by the two diagnostic systems was 0.78 and 89.5%, respectively. The median platelet count was lower and FDP level was higher in the patients diagnosed by ISTH criteria than in patients diagnosed by KSTH criteria. CONCLUSION: The agreement between ISTH and KSTH criteria was significantly high.

Clinicopathologic Significance of Multidrug Resistance Protein Expression in Patients with Stage III Gastric Adendegrees Carcinoma / 대한암학회지

PURPOSE: We wanted to determine the prognostic significance of P-glycoprotein (Pgp) and multi drug resistance-assdegrees Ciated protein (MRP) in stage III gastric adendegrees Carcinoma by evaluating whe ther the Pgp and/or MRP expression correlate with various clinicopathological parameters and survival rates. MATERIAL AND METHODS: The expression of Pgp and/or MRP were studied immunohistdegrees Chemi cally by ABC method with paraffin-embedded tissue specimens which were surgically obtained from 64 cases of stage III gastric adendegrees Carcinomas at the Department of Surgery, Presbyterian Medical Center from 1991 to 1992. Statistical differences of both expression in various factors including survival rates and clinicopatholgical parameters were sought. RESULTS: Expression rates of Pgp and MRP group were 50.0% and 43.7% respectively. There was no significant correlation between expression of two proteins and various clinicopathological variables such as age, sex, stage, tumor depth, number of metastatic node, tumor size, site and method of operation. However, in case of the degree of differenciation, the expression of Pgp and/or MRP was significantly greater in well differenciated adendegrees Carcinoma than in poorly dif ferenciated adendegrees Carcinoma (p=0.001, p=0.012). Statistically, no significant correlations between the expression of Pgp and/or MRP and overall survival rates were found. CONCLUSION: These results suggest that the Pgp and/or MRP expression in patients with stage III gastric adendegrees Carcinomas are not useful in determining postoperative chemotherapy and as an independent predictor of survival.