There are numerous studies about the transformation of renal pathology during lupus nephritis progression. A number of researchers suggest that patients with previous proliferative glomerulonephritis may not need to repeat renal biopsy in relation to treatment strategies. However, the pathology of renal biopsy could offer important information to clinicians about the progression of disease. Here, we report a rare case of the convertion of ISN/RPS classification from a proliferative lesion to a wholly non-proliferative lesion. A 40-year-old female was admitted complaining of generalized edema for 1 month. At the age of 33 she had been diagnosed as SLE with proliferative lupus nephritis. The renal remission was induced with corticosteroid pulse therapy and 12 cycles of intravenous cyclophosphamide treatment. The repeated renal biopsy revealed class V lupus nephritis compared with referential biopsy of class IV-G. A better prognosis is expected with lower activity and a lower chronicity index. Repeat renal biopsy may give useful information relating to the prognosis of nephritis.
Adult ; Biopsy ; Cyclophosphamide ; Edema ; Female ; Glomerulonephritis ; Humans ; Lupus Nephritis ; Nephritis ; Prognosis

Most patients experiencing an osteoporotic vertebral compression fracture remain asymptomatic or minimally symptomatic. However, a notable number of these patients do experience significant pain at some time resulting in disability and decreased quality of life. A 77-year-old man was admitted to a hospital with severe thoracolumbar pain and functional disabilities even though, 12 months ago, he had received inpatient treatment for 6 months in another hospital with the diagnosis of T12 vertebral compression fracture. Although initial outside spine MRI revealed a stable T12 com pression fracture with a 27.6% compression rate, delayed subsequent re-fracture of the same vertebrae was found on simple X-ray and thoracolumbar CT scan with an 86.5% compression rate and retropulsion to the central spinal canal. He continued to have severe spinal pain and functional disabilities in spite of undergoing a first anterolateral fusion one year ago and a subsequent posterior fusion. We emphasize a proper clinical and radiologic examination at one-year follow-up after successful conservative treatment of vertebral compression fractures.
Aged ; Follow-Up Studies ; Fractures, Compression ; Humans ; Inpatients ; Quality of Life ; Spinal Canal ; Spine

A 50-year-old man with liver cirrhosis and esophageal varix for 3 years was diagnosed with hematemesis and treated for a bleeding varix. However, bleeding recurred 11 days later, and he developed drowsiness with left hemiparesis. His left upper and lower extremity muscle strengths based on the manual muscle test at the onset were grade 2/5 and 1/5, respectively. The Babinski sign was positive. His serum ammonia level was elevated to 129.9 microg/dL (normal, 20-80 microg/dL). Magnetic resonance imaging revealed restriction on diffusion and T2-hyperintensities with decreased apparent diffusion coefficient values in the bilateral frontoparietooccipital cortex. The effect was more severe in the right hemisphere and right parietooccipital cortices, which were compatible with hepatic encephalopathy. Although the patient's mental status recovered, significant left-sided weakness and sensory deficit persisted even after 6 months. Diffusion tensor tractography (DTT) performed 3 months post-onset showed decreased volume of the right corticospinal tract. We reported a patient with hepatic encephalopathy involving the corticospinal tract by DTT.
Ammonia ; Diffusion Tensor Imaging ; Diffusion* ; Esophageal and Gastric Varices ; Hematemesis ; Hemorrhage ; Hepatic Encephalopathy* ; Humans ; Liver Cirrhosis ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Muscle Strength ; Paresis ; Pyramidal Tracts* ; Reflex, Babinski ; Rehabilitation ; Sleep Stages ; Varicose Veins

OBJECTIVE: To determine abnormal MRI findings in adults hospitalized with acute severe axial LBP. METHOD: Sixty patients with back pain were divided into 3 groups consisting of 1) 23 adults with acute axial severe LBP who could not sit up or stand up for several days, but had not experienced previous back-related diseases or trauma (group A), 2) 19 adults who had been involved in a minor traffic accident, and had mild symptoms but not limited mobility (group B), and 3) 18 adults with LBP with radicular pain (group C)., Various MRI findings were assessed among the above 3 groups and compared as follows: disc herniation (protrusion, extrusion), lumbar disc degeneration (LDD), annular tear, high intensity zone (HIZ), and endplate changes. RESULTS: The MRI findings of A group were as follows: disc herniation (87%), LDD (100%), annular tear (100%), HIZ (61%), and end plate changes (4.4%). The findings of disc herniation, annular tear, HIZ, and LDD were more prevalent in A group than in B group (p<0.01). HIZ findings were more prevalent in A group than in group B or group C (p<0.05). CONCLUSION: Patients with acute severe axial LBP were more likely to have disc herniation, LDD, annular tear, HIZ. Among LBP groups, there was a significant association of HIZ on MRI with acute severe axial LBP.
Accidents, Traffic ; Adult ; Back Pain ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets

About 90% of primary gastrointestinal lymphomas originate from the B-cell and less than 10% from the T-cell. In respect of anatomical location, the stomach is the most common site of gastrointestinal lymphomas followed by the ileum, colon, and rectum. However, esophagus and duodenal lymphomas are infrequently involved. Primary T-cell lymphoma of the duodenum is not common and peripheral T-cell lymphoma of the duodenum is very rare. In Korea, there has been no case report of peripheral T-cell lymphoma which simultaneously involved the stomach and duodenum. In this report, we present a case of primary peripheral T-cell lymphoma of the duodenum and stomach. A 63-year-old man was hospitalized complaining of weight loss of 15 kg and dyspepsia for 2 months. Esophagogastroduodenoscopy showed a large annular infiltrative lesion in the descending portion of the duodenum. At the posterior side of the upper body of the stomach, an ill-defined, broad, flat, and infiltrative lesion was also noted. Microscopic examination of the biopsy specimen showed that atypical bizzare lymphocytes infiltrated the mucosa of the duodenum and stomach. The lymphocyte was positive for CD3, CD5 and negative for CD20, CD23, and CD56 by immunohistochemistry. We made a diagnosis of primary peripheral T-cell lymphoma of the stomach and duodenum. We report a case of peripheral T-cell lymphoma of the stomach and duodenum with a review of the literature.
B-Lymphocytes ; Biopsy ; Colon ; Diagnosis ; Duodenum* ; Dyspepsia ; Endoscopy, Digestive System ; Esophagus ; Humans ; Ileum ; Immunohistochemistry ; Korea ; Lymphocytes ; Lymphoma ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral* ; Middle Aged ; Mucous Membrane ; Rectum ; Stomach* ; T-Lymphocytes ; Weight Loss

OBJECTIVE: To determine the relation between postvoid residual (PVR) and the occurrence of urinary tract infection (UTI) in stroke patients. METHOD: One hundred and eighty-eight stroke patients who were admitted to an inpatient rehabilitation unit and who did not have UTI on admission (105 males, 83 females, mean age 67.1 years) were included in this study. The PVR was measured 3 times within 72 hours after admission. Mean PVR, demographic variables, K-MMSE (Korean Mini-Mental State Examination), initial K-MBI (Korean Modified Barthel Index), Foley catheter indwelling time and stroke type were defined and the relation to the occurrence of UTI was analyzed. RESULTS: UTI occurred in 74 patients (39.4%) during admission to the rehabilitation unit. There were significant differences between the UTI and non-UTI groups in K-MMSE, K-MBI, Foley catheter indwelling time (p<0.01). However, age, gender, stroke location and type were not associated. The occurrence of UTI was 4.87 times higher in the patients with a mean PVR over 100 ml than in those with a mean PVR <100 ml. The mean PVR was 106.5 ml in the UTI group, while it was 62.7 ml in the non-UTI group (p<0.01). PVR was not associated with age. CONCLUSION: The UTI rate is higher when the mean PVR is over 100 ml irrespective of gender and age. Close monitoring of PVR and appropriate intervention is needed to reduce the occurrence of UTI in stroke patients.
Catheters ; Female ; Humans ; Inpatients ; Male ; Stroke ; Urinary Tract ; Urinary Tract Infections

OBJECTIVE: To examine the usefulness of the Scale for the Assessment and Rating of Ataxia (SARA) in ataxic stroke patients. METHOD: This was a retrospective study of 54 patients following their first ataxic stroke. The data used in the analysis comprised ambulation status on admission and scores on the SARA, the Korean version of the Modified Barthel Index (K-MBI) and the Berg Balance Scale (BBS). The subjects were divided into four groups by gait status and into five groups by level of dependency in activities of daily living (ADLs) based on their K-MBI scores. Data were subjected to a ROC curve analysis to obtain cutoff values on the SARA for individual gait status and levels of activity dependency. The correlations between the SARA, K-MBI and BBS scores were also computed. RESULTS: There was significant correlation between the SARA and the K-MBI scores (p<0.001), and this correlation (r=-0.792) was higher than that found between the BBS and the K-MBI scores (r=0.710). The SARA scores of upper extremity ataxia categories were significantly related to the K-MBI scores of upper extremity related function (p<0.001). The SARA scores were also significantly correlated negatively with ambulation status (p<0.001) and positively with ADL dependency (p<0.001). In the ROC analysis, patients with less than 5.5 points on the SARA had minimal dependency in ADL, while those with more than 23 points showed total dependency. CONCLUSION: SARA corresponds well with gait status and ADL dependency in ataxic stroke patients and is considered to be a useful functional measure in that patient group.
Activities of Daily Living ; Ataxia ; Dependency (Psychology) ; Gait ; Humans ; Retrospective Studies ; ROC Curve ; Stroke ; Upper Extremity ; Walking

Bilateral paramedian thalamic infarction is a rare subtype of stroke caused by occlusion of the artery of Percheron, an uncommon variant originating from one of the posterior cerebral arteries. This type of stroke has several major clinical presentations: altered mental status, behavioral amnestic impairment, aphasia or dysarthria, ocular movement disorders, motor deficits, cerebellar signs, and others. Few cases of bilateral paramedian thalamic infarction-related pseudobulbar palsy characterized by dysarthria, dysphagia, and facial and tongue weakness have been reported. We report here a rare case of acute severe pseudobulbar palsy as a manifestation of bilateral paramedian thalamic infarction.
Aphasia ; Arteries ; Deglutition Disorders ; Dysarthria ; Infarction* ; Movement Disorders ; Posterior Cerebral Artery ; Pseudobulbar Palsy* ; Stroke ; Thalamus ; Tongue

Systemic lupus erythematosus (SLE) is an autoimmune disease with various manifestations, while its autoantibodies and immune reactions involve multiple organs. Neuropsychiatric involvement in SLE is known to be common, however, peripheral neuropathy is relatively rare. Guillain-Barre syndrome is clinically defined as an acute demyelinating peripheral neuropathy causing weakness and numbness in the legs and arms. We describe a case of Guillain-Barre syndrome with antiphospholipid syndrome and lupus nephritis. The patient was admitted with fever and diarrhea. He developed progressive weakness of the upper and lower extremities and dysarthria with characteristic nerve conduction patterns compatible with Guillain-Barre syndrome. He also had proteinuria and gangrene of the hand and toe with antiphospholipid antibody. He received intravenous immunoglobulin and plasmapheresis for progressive neuropathy, intravenous high dose steroid to control activity of SLE, and anticoagulation for antiphospholipid syndrome. Neuropsychiatric manifestation of SLE is related to lupus activity closely, so it is important to control lupus activity.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Arm ; Autoantibodies ; Autoimmune Diseases ; Diarrhea ; Dysarthria ; Fever ; Gangrene ; Guillain-Barre Syndrome ; Hand ; Humans ; Hypesthesia ; Immunoglobulins ; Leg ; Lower Extremity ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Neural Conduction ; Peripheral Nervous System Diseases ; Plasmapheresis ; Proteinuria ; Toes

OBJECTIVE: To investigate the risk factors for poststroke delirium and evaluate its influence on functional recovery after ischemic stroke. METHOD: Risk factors for delirium were investigated retrospectively in three hundred twenty nine acute ischemic stroke patients over 60 years of age. Among the 329 patients, sixty seven developed delirium. Data were analyzed between delirium group (n=22) and control group (n=22) according to age, sex, lesion location and clinical features. Korean modified Barthel index (K-MBI), Korean National Institutes of Health stroke scale (K-NIHSS) and Korean mini-mental state examination (KMMSE) were measured at second and sixth weeks after onset and compared for both groups. RESULTS: Parameters showing statistically significant difference between two groups were age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. There was no significant difference in K-MBI, K-NIHSS and K-MMSE scores at second week between the two groups. The delirium group showed significantly less improvement in K-MBI and K-NIHSS scores compared to control group (9.5+/-10.2 vs 18.5+/-11.6, p=0.011; -0.7+/-1.2 vs -1.8+/-1.3, p=0.014). There was no significant improvement in K-MMSE score. CONCLUSION: The possible risk factors for delirium in acute ischemic stroke are age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. Stroke patients with comorbid delirium showed poorer functional outcome. Delirium seems to have detrimental effect in functional recovery after stroke.
Delirium ; Embolism ; Humans ; Hyponatremia ; National Institutes of Health (U.S.) ; Prognosis ; Retrospective Studies ; Risk Factors ; Sleep Deprivation ; Stroke