BACKGROUND: Creutzfeldt-Jakob disease (CJD) shares common clinical features with Hashimoto's encephalopathy (HE). The 14-3-3 protein is a relatively sensitive and specific marker of CJD but is not commonly detected in HE. We report the case of a patient with HE with unusual features including positive 14-3-3 protein in the cerebrospinal fluid (CSF) and an atypical course mimicking that of CJD. CASE REPORT: A 64-year-old male was admitted due to acute-onset cognitive dysfunction. HE was suspected based on increased titers of anti-thyroid microsomal antibody and an excellent response to steroid. However, 14-3-3 protein was detected in the CSF and a recurrent attack with progressive cognitive decline, pyramidal symptoms and myoclonus mimicking CJD occurred. Cognitive dysfunction showed progressive worsening and the response to steroid treatment was decreased. CONCLUSIONS: 14-3-3 protein could be considered a general marker of neuronal destruction and not specific to CJD. The clinical manifestations of HE are variable and its diagnosis is difficult due to the lack of a specific phenotype and reliable diagnostic criteria. We recommend that patients with clinical features of CJD and antithyroid antibodies should be considered for empirical steroid treatment for HE, despite a positive result for 14-3-3 protein.
14-3-3 Proteins* ; Antibodies ; Cerebrospinal Fluid* ; Creutzfeldt-Jakob Syndrome* ; Diagnosis ; Humans ; Male ; Middle Aged ; Myoclonus ; Neurons ; Phenotype

PURPOSE: To study the clinical manifestations and surgical outcome of infantile esotropia. METHODS: This review retrospectively examined 165 patients of infantile esotropia who had undergone recession of bilateral medial rectus muscles from April 1991 to September 2001 at our institute. We measured the binocular alignment and analyzed the long term surgical outcome. RESULTS: The average angle of deviation of 165 patients was 45.9 +/- 13.99PD (25 ~ 90PD) and the average refractive error was +sph 1.18 +/- 2.25D (-sph 7.00 ~ +sph 6.00D). Amblyopia was found in 48.4% of the patients, DVD in 12.7%, IOOA in 11.3%, and manifest latent nystagmus in 6.0%. A binocular alignment within 10 PD was achieved in 73.9% and 57.9% at the 2nd and 4th post-operative year respectively. CONCLUSIONS: The surgical outcome of bimedial rectus muscle recession in infantile esotropia was satisfactory in 74%, and 58% of the patients at the 2nd and 4th post-operative year respectively.
Amblyopia ; Esotropia* ; Humans ; Muscles ; Refractive Errors ; Retrospective Studies ; Telescopes

Earlier report showed that expression of a splice variant of CD99 transmembrane protein increases invasive ability of human breast cancer cells. Cell motility was also significantly enhanced by the CD99 splice variant expression. In an effort to identify the cellular components that mediate a signal transduction pathway triggered by the CD99 splice variant, known signal path inhibitors were examined for their effects on the motility of the CD99 splice variant-transfected MDA-MB-231 breast cancer cells. Phenylarsine oxide, an inhibitor of phosphatase specific for focal adhesion kinase, and PP1, an inhibitor of src kinase family, significantly suppressed motility of the cells. Among different types of src transfectant clones generated, kinase-negative mutant src transfectant cells were 80% less motile than the mock cells transfected with an empty-vector, while v-src and c-src transfectants exhibited cell motility levels at or slightly above the mock transfectant. These results suggest that src and focal adhesion kinase mediate the intracellular signaling pathway of a CD99 splice variant for the induction of motility of human breast cancer cells.
Antigens, CD/*genetics ; Arsenicals/pharmacology ; Breast Neoplasms/*enzymology/genetics/*pathology ; Cell Adhesion Molecules/*genetics ; Cell Movement/drug effects ; Gene Expression ; Protein-Tyrosine Kinase/antagonists & inhibitors/*metabolism ; Pyrazoles/pharmacology ; Pyrimidines/pharmacology ; Signal Transduction/drug effects ; Transfection ; Tumor Cells, Cultured ; src-Family Kinases/antagonists & inhibitors/*metabolism

Carcinoid tumors originate from the enterochromaffin cells. Rectal carcinoid tumors comprise 12.6% of all carcinoid tumors and they represent the third largest group of the gut carcinoids. However, a recent report showed that the number of reported cases has increases rapidly, which is probably due to the increased number of colonoscopic examinations. The aggressiveness of rectal carcinoid tumors is determined by the depth of invasion and the presence of metastasis. The clinical course of rectal carcinoid is benign, but these tumors may have a malignant character when the lesion is larger than 2 cm in diameter. We have experienced a case of rectal carcinoid tumor smaller than 2 cm in diameter and the patient had multiple liver metastasis.
Carcinoid Tumor ; Enterochromaffin Cells ; Humans ; Liver ; Neoplasm Metastasis ; Rectum

BACKGROUND AND PURPOSE: The relationship between the side of motor symptoms and cognitive impairment has rarely been reported in Parkinson’s disease (PD). We aimed to estimate the influence of motor laterality on cognition in PD patients. METHODS: We enrolled 67 patients with PD, and they were divided into two groups according to side of symptom onset or predominant motor symptom presentation (right and left). Right-sided PD (RPD, 40) and left-sided PD (LPD, 27) patients underwent a neuropsychological battery exploring memory, attention/working memory, frontal/executive, visuospatial, and language functions. Student's t-test and Chi-square test have been carried out to compare the clinical and neuropsychological data between two groups. RESULTS: There were no significant differences in any neuropsychological test between the RPD and LPD groups, except for digit forward span test. RPD patients scored lower on the digit forward span test than LPD patients (5.43±9.49 vs. 6.15±1.38, p=0.045). CONCLUSIONS: RPD patients seem to experience more difficulties in attention and working memory than did LPD patients. The laterality of motor symptoms is not a major determinant for cognitive impairment in PD patients but, we should consider differences of cognitive deficits depending on the side of motor symptoms to treat patients with PD.
Cognition ; Cognition Disorders* ; Humans ; Memory ; Memory, Short-Term ; Neuropsychological Tests ; Parkinson Disease*

We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.
Angiography ; Brain ; Carotid Artery, Common ; Dizziness ; Emergencies ; Hemorrhage ; Humans ; Infarction ; Middle Aged ; Reflex, Babinski ; Seizures ; Stroke* ; Thorax ; Tissue Plasminogen Activator

BACKGROUND AND PURPOSE: There is conflicting evidence for whether or not the incidence of stroke is influenced by the daily temperature. The association between daily temperature and incidence of stroke is largely unknown in Korea. This study attempted to evaluate whether the maximum or minimum daily temperature is associated with increased numbers of strokes and stroke subtypes among Seoul residents. METHODS: We obtained the maximum and minimum daily temperatures in Seoul from the Korean Meteorological Administration between January 2005 and December 2014. Consecutive patients with acute stroke were registered who visited the emergency room or outpatient clinic in Soonchunhyang University Hospital, Seoul. The residential addresses of cases were restricted to within a 2-kilometer radius of this hospital. The stroke events were prospectively recorded with onset time, and were classified by subtypes. The categories of daily temperature were divided by 10℃ from the mean temperature. The mean daily number of strokes was calculated during the study period. One-way analysis of variance and Duncan's post-hoc test were applied to compare the number of strokes among the temperature groups. RESULTS: In total, 2,313 acute strokes were identified during the period: 1,643 ischemic strokes and 670 hemorrhagic strokes. The number of cases was significantly higher when the maximum daily temperature was >32℃ or ≤3℃ (p=0.048) or the minimum daily temperature was ≤-11.0℃ (p=0.020). The lowest maximum daily temperature was associated with increased instances of intracerebral hemorrhage (p=0.029) and small-vessel occlusion (p=0.013), while the highest maximum daily temperature was associated with an increased instance of large-artery atherosclerosis (p=0.045). CONCLUSIONS: The daily temperature had measurable and different associations with the number of strokes and strokes subtypes in Seoul, Korea.
Ambulatory Care Facilities ; Atherosclerosis ; Cerebral Hemorrhage ; Emergency Service, Hospital ; Humans ; Incidence ; Korea ; Prospective Studies ; Radius ; Seoul* ; Stroke*

We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depression of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normalization of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection.
Acute Disease ; Blood Coagulation Factors/metabolism ; Child, Preschool ; Hepatitis A/blood/diagnosis/*etiology ; Humans ; Male ; Mycoplasma pneumoniae/pathogenicity ; Partial Thromboplastin Time ; Pneumonia, Mycoplasma/blood/*complications

BACKGROUND: HLA antibodies have been shown to be associated with graft loss of organ transplants in prior studies. This study was designed to analyze the results of ELISA- panel reactive antibody (ELISA-PRA) in kidney transplant patients and the impact of this test on the clinical outcome. METHODS: We have investigated ELISA-PRA results from 110 living donor renal transplant patients from Nov. 2001 to Apr. 2004. RESULTS: ELISA-PRA positivity was found in 22 (20%) patients and was higher in the female patients than male (P<0.05). Pretransplant transfusion, pregnancy or transplantation history was not significantly correlated with ELISA- PRA result. ELISA-PRA (+)patients had more rejection episodes of 41% (n=9) (P=0.0005) and graft failures of 18% (n=4) (P=0.028) than ELISA-PRA (-), which had 8% (n=7) and 3% (n=3), respectively. Patients group with a result of ELISA-PRA/flowcytometric crossmatch (FCXM) (+/ -) or (+ / +) had worse clinical outcome than ELISA- PRA/FCXM ( -/- ). ELISA-PRA/FCXM (+ /+ ) correlated with higher incidence of allograft rejection than ELIS- PRA/FCXM (+ /- ) or ( -/+ ). CONCLUSION: These results suggest that in conjunction with FCXM results, pretransplant ELISA-PRA test is useful predictor of clinical outcome in renal transplant recipients.
Allografts ; Antibodies ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Incidence ; Kidney* ; Living Donors ; Male ; Pregnancy ; Transplantation ; Transplants

OBJECTIVE: To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. METHOD: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. RESULTS: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p<0.05). CONCLUSION: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients.
Brain ; Brain Injuries ; Cholinergic Antagonists ; Epidemiologic Studies ; Equidae ; Hemorrhage ; Humans ; Infarction ; Infarction, Anterior Cerebral Artery ; Inpatients ; Nocturia ; Outpatients ; Prevalence ; Prospective Studies ; Prostate ; Quality of Life ; Stroke