Squamous cell carcinoma of the renal pelvis is an uncommon tumor, comprising about 0.5-2% of all primary malignant tumor of the kidney. The patients of this disease usually presented late with extensive local infiltration. In addition, poor response to surgery, radiotherapy and chemotherapy result in a poor prognosis and short survival. We report a patient of squamous cell carcinoma of renal pelvis with staghorn calculi in a 66-year-old woman who had a history of right sided renal colic and palpable abdominal mass.
Aged ; Calculi* ; Carcinoma, Squamous Cell* ; Drug Therapy ; Female ; Humans ; Kidney ; Kidney Pelvis* ; Prognosis ; Radiotherapy ; Renal Colic

PURPOSE: This study was made to evaluate the clinical characteristics and the treatment of the gangrene of the male genitalia manifested with progressive life threatening disease. MATERIALS AND METHODS: Between June 1992 and December 1998, medical records for patients with Fournier's gangrene were reviewed with respect to age at presentation, associated disease, and clinical course and the treatment. RESULTS: The age of patients ranged from 29 to 92 years. The prodromal sign noted were usually low abdominal and inguinal pain. There were no differences in the causative pathogens compared to those of previous reports. The common underlying diseases were diabetes and chronic liver disease. Hypoalbuminemia and leukocytosis were found in all. Early radical debridement and aggressive antibiotics therapy were performed in all cases. Reconstructive surgery of defected skin was performed 7 to 45 days(mean 33.6) after debridement and period of hospital stay ranged from 14 to 123 days(mean 35.8). The motality rate was 13.3%. CONCLUSIONS: It is thought that the motality rate of Fournier`s gangrene is reduced by early aggresseve debridement of the wound and empirical triple antibiotic therapy, and the comprehension of clinical course is important as well.
Anti-Bacterial Agents ; Comprehension ; Debridement ; Fournier Gangrene ; Gangrene* ; Genitalia, Male ; Humans ; Hypoalbuminemia ; Length of Stay ; Leukocytosis ; Liver Diseases ; Male ; Medical Records ; Prodromal Symptoms ; Skin ; Wounds and Injuries

Obstructive sleep apnea (OSA) is a common disorder which is characterized by intermittent upper airway collapse occurring during sleep. It is well known that OSA often results in a wide range of comorbid disorders. I introduce here what OSA brings to the patients in neurologic department. Epidemiological studies have shown that OSA is associated with cognitive impairment, headache, metabolic syndrome, various cardiovascular diseases including hypertension, ischemic heart disease, arrhythmia, and stroke. Motor vehicle accident is not seemed to be related to a neurological condition but it can be also related in terms of excessive daytime sleepiness and decreased attention in patients with OSA. Obstructive respiratory events like apnea, hypopnea, and respiratory effort related arousal cause repetitive hypoxia, hypercarpnea, arousal, and decreased intrathoracic pressure. In turn, these can increase blood pressure, sympathetic activity, insulin resistance, and left ventricular wall tension. Consequentially, these processes can be considered as possible mechanism. Although further researches are needed to prove that OSA is independent cause of comorbid conditions, OSA especially in moderate or severe cases can develop and aggravate such conditions as risk factor. So we should know what OSA brings to us and pay attention whether OSA is combined in the patients whom we meet in neurological department.
Anoxia ; Apnea ; Arousal ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular Diseases ; Comorbidity ; Headache ; Humans ; Hypertension ; Insulin Resistance ; Motor Vehicles ; Myocardial Ischemia ; Neurology ; Risk Factors ; Sleep Apnea, Obstructive ; Stroke

Optic perineuritis is characterized by optic disc swelling with normal visual acuity, pupillary responses and intracranial pressures, and normal visual fields except for an enlarged blind spot that may be confused with papilledema caused by brain tumor or pseudotumor cerebri. It is a rare manifestation of neurosyphilis, and it is thought to represent an extension of basal meningeal inflammation to the optic nerve sheaths. Serum VDRL tests are negative in a significant proportion of patients with late syphilis, particularly in those with neurosyphilis(seronegative syphilis). We present a case of optic perineuritis associated with seronegative neurosyphilis.
Brain Neoplasms ; Humans ; Inflammation ; Intracranial Pressure ; Neurosyphilis* ; Optic Disk ; Optic Nerve ; Papilledema ; Pseudotumor Cerebri ; Syphilis ; Visual Acuity ; Visual Fields

Obstructive sleep apnea (OSA) is a common disorder characterized by obstructive apneas, hypopneas, and respiratory effort related arousals during sleep. Treatment of OSA is important because untreated patients have potential adverse clinical outcomes, such as excessive daytime sleepiness, metabolic dysfunction, cardiovascular disease, and mortality. Therefore, OSA should be considered as a chronic disease that requires long-term and multidisciplinary care. Positive airway pressure (PAP) therapy is the mainstay of treatment for OSA in adults. Alternative therapies include oral appliance, behavioral modification, and upper airway surgery. The treatment of OSA in adults is reviewed here with focus on PAP therapy.
Adult* ; Apnea ; Arousal ; Cardiovascular Diseases ; Chronic Disease ; Complementary Therapies ; Humans ; Mortality ; Sleep Apnea, Obstructive*

Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.
Aged ; Aphasia* ; Brain ; Hand ; Humans ; Infarction ; Stroke ; Temporal Lobe

Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.

Melatonin is an endogenous chronobiological regulator secreted mainly from the pineal gland, which has been used as a dietary supplement in the treatment of sleep problems, including insomnia, parasomnia, and circadian rhythm sleep disorders. However, the short half-life and rapid metabolism of melatonin limit its suitability as a drug. There are many melatonergic drugs used in the treatment of sleep disorders and several drugs are under investigation for approval. Ramelteon was the first melatonergic agonist approved as hypnotic agent by U.S. Food and Drug Administration for the treatment of insomnia. It exhibits higher selective affinity for melatonin 1a (MT1) receptor than melatonin 1b (MT2) receptor. This selectivity suggests that it targets sleep onset with no significant adverse effect or dependency. Agomelatin, naphtahalenic compound, act as a potent MT1/MT2 melatonergic receptor agonist and serotonergic receptor antagonist was approved for treatment of depression in 2009. This dual action drug is the first melatonergic agent used in depression. Another melatonergic agonist, tasimelteon has high affinity for the MT1/MT2 receptors in humans. It was approved for the treatment of non-24 hours sleep-wake rhythm disorder. The newly developed melatonin and melatonergic drugs have the potential to be used extensively in various clinical situations and substitute the old benzodiazepine and its derivatives in the treatment of insomnia. However, the efficacy and safety of newly developed melatonergic drugs should be elucidated through long-term clinical trials.

Obstructive sleep apnea (OSA), a common comorbidity in patients with stroke, has shown increasing prevalence over the past few decades. OSA is an important risk factor for stroke in addition to other well-known contributors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. Moreover, OSA is an independent predictor of neurological outcomes and mortality. The pathological mechanisms underlying the association between OSA and stroke include autonomic dysfunction, hypertension, cardiac arrhythmia, dyslipidemia, impaired glucose tolerance, hypoxia, and inflammation. Continuous positive airway pressure (CPAP) therapy has proven clinical utility in improvement of neurological symptoms in patients with stroke. Findings from a CPAP withdrawal model have shown increased sympathetic activity in OSA with a consequent significant elevation in blood pressure, relevant cerebral hypoxia, and disturbed cardiac repolarization. In this review, we present an overview of the literature that describes an association between OSA and stroke in addition to the vascular risk factors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. This study highlights the importance of early and accurate diagnosis and management of OSA for stroke prevention and care and will benefit physicians in clinical practice.