BACKGROUND: Neuron-specific enolase (NSE) is a useful indicator of neuronal injury in acute cerebral infarction. We investigated the changes in serial serum NSE levels in patients with acute cerebral infarction. METHODS: We measured serial serum NSE levels at 24, 48, 72, and 96 hours, and 2 weeks after the onset of cerebral infarction in 30 patients (15 territorial and 15 lacunar infarctions). We also measured the NSE levels in age-matched controls (n=15) who had no evidence of acute stroke or other neurological disorders. The NSE level was measured using a radioimmunoassay. RESULTS: The initial serum NSE level was significantly higher in the cerebral infarction group than in the control group (6.6+/-2 vs 4.7+/-1.6 ng/mL [mean+/-SD], p=0.006). This difference was also observed between the territorial and lacunar infarction groups until 72 hours after the cerebral infarction. The serum NSE level peaked at 72 hours after the infarction in both lacunar and territorial infarction groups. The correlation between the NSE level and the score on the NIH Stroke Scale was strongest at 48 hours after the cerebral infarction (r=0.469). CONCLUSIONS: Serum NSE level can be a good indicator for distinguishing lacunar from territorial infarction during the acute stage of cerebral infarction.
Cerebral Infarction ; Humans ; Infarction ; Nervous System Diseases ; Neurons ; Phosphopyruvate Hydratase ; Stroke ; Stroke, Lacunar

BACKGROUND: Measurements of coronary flow reserve(CFR) and phasic coronary flow profile are useful in assessment of the physiologic significance of coronary lesions. However, alterations in hemodynamic status are known to influence coronary flow reserve. The purpose of this study was to assess the effect of increase in heart rate on maximal pharmacologin coronry flow reserve and phasic flow pattern. METHODS: We investigated 12 patients(9 females and 3 males, mean age : 49+/-12 years) with normal coronary artery and atypical chest pain syndrome for the measurement of CFR and coronary flow profile. CFR and systolic and diastolic coronary flow velocity integral(CFVI) were measured at the proximal portion of left anterior descending artery with 0.018 inch(12MHz) Doppler guide wire before and during intracoronary injection of 12 mcg of adenosine. The heart rate at the baseline ranging from 62 beats/min to 79 beats/min(mean : 70+/-5 beats/min) was increased to 100 beats/min and again to 120 beats/min by right atrial pacing. RESULTS: CFR progressively decreased from 3.0+/-0.5 at baseline to 2.4+/-0.4 during pacing at 100 beats/min and to 2.0+/-0.3 during pacing at 120 beats.min(p<0.001). CFVI/min at baseline was progressively increased(130+/-15% of control value at 100 beats.min, 135+/-30% at 120 beats.min(p<0.01) whereas in adenosine hyperemia remained unchanged(286+/-81% at hyperemia baseline, 296+/-91% at 100 beats/min, 289+/-105% at 120 beats/min, p>0.05). Systolic CFVI/min was increased at baseline(185+/-35% at 120 beats/min, p<0.01) and in adenosine hyperemia(377+/-153% at hyperemia baseline, 457+/-178% at 120 beats/min, p=0.01). Diastolic CFVI/min was increased at baseline(134+/-178% at 120 beats/min, p<0.01), but in adenosine hyperemia, no significant change was observed(278+/-77% at hyperemia baseline and 251+/-77% at 120 beats/min, p>0.05). CONCLUSION: Increase in heart rate induces a substantial reduction in maximal CFR. Thus,heart rate appears to be one of important variable for the measurement of CFR and phasin coronary flow profile.
Adenosine ; Arteries ; Chest Pain ; Coronary Vessels ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hyperemia ; Male

Mediastinal parathyroid cyst is a very rare disease and is usually found incidentally. Surgical excision is the treatment of choice and recurrence is very rare when complete excision is done. A 71-year-old man was referred to our department because of 6x5cm sized right superior mediastinal mass found incidentally on chest X-ray. Surgical excision was performed and pathologic findings were confirmed as mediastinal parathyroid cyst. The patient has been followed up postoperatively without recurrence for 4 months up to now. We report a case of mediastinal parathyroid cyst.
Aged ; Humans ; Mediastinal Cyst ; Parathyroid Glands ; Parathyroid Neoplasms ; Rare Diseases ; Recurrence ; Thorax

Pseudoaneurysm is one of the undesirable complications of interventional cardiology procedures involving peripheral puncture site. Nowadays, it is not uncommon as a consequences of more complex interventional preocedures, larger catheters and prolonged anticoagulation treatment. Surgical repair has been mainstay of treatment for pesudoaneurysm. However, sucessful closures of pseudoaneurysms have been reported recently by using direct compression guided by color doppler ultrasound. We report a case of pseudoaneurysm in femoral artery, which was developed at the right inguinal puncture site in 38 year old male patient with unstabel angina who had received continuous intravenous infusion of heparin and had undergone coronary angiography treated successfully with direct compression guided by color doppler ultrasound.
Adult ; Aneurysm, False* ; Cardiology ; Catheters ; Coronary Angiography ; Femoral Artery* ; Heparin ; Humans ; Infusions, Intravenous ; Male ; Punctures ; Ultrasonography*

Chronic acquired hepatocerebral degeneration (CAHD) is a progressive or episodic neurologic syndrome that occurs occasionally in patients who have chronic liver disease or portocaval shunt. The clinical features of CAHD include action and postural tremors, generalized chorea, asterixis, myoclonus, dystonia, resting tremor, gait ataxia, and variable impairments of intellectual function. We experienced 2 cases of CAHD with unusual neurologic manifestations, which were hypokinetic parkinsonian symptoms. Both cases had a history of liver cirrhosis and the same symptoms. They had masked faces, cogwheel rigidiy in both wrists, slurred speech, tongue tremor, bradykinesia, and gait ataxia. They had normal mental status and no pathologic reflex. Brain MRI showed abnormal, increased signal on T1-weighted images in the globus pallidus and mesencephalon bilaterally. The hypokinetic parkinsonian symptoms disappeared when given doses levodopa.
Brain ; Chorea ; Dyskinesias ; Dystonia ; Gait Ataxia ; Globus Pallidus ; Hepatolenticular Degeneration* ; Humans ; Hypokinesia ; Levodopa ; Liver Cirrhosis ; Liver Diseases ; Magnetic Resonance Imaging ; Masks ; Mesencephalon ; Myoclonus ; Neurologic Manifestations ; Reflex ; Tongue ; Tremor ; Wrist

Thymic carcinoid or neuroendocrine tumor of thymus is a very rare disease and has poor prognosis due to frequent recurrence and distant metastasis. A 43-year-old man was refered to our hospital because of Rt. chest pain and tightness. Chest X-ray revealed 7 X 8cm sized mass on Rt. anterior mediastinum. Surgical excision was performed and light microscopic, immunohistochemical and electron microscopic findings were confirmed as atypical thymic carcinoid tumor with thymic cyst. The patient has been followed up without recurrence or distant metastasis postoperatively for 3 months to now. We report a case of atypical thymic carcinoid with thymic cysts.
Adult ; Carcinoid Tumor* ; Chest Pain ; Humans ; Mediastinal Cyst* ; Mediastinum ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Prognosis ; Rare Diseases ; Recurrence ; Thorax ; Thymus Gland

Regulation for new standardized rescue record from of the 119 EMS system was established by law from February 1, 1998. We have recently evaluated the effectiveness of the record from. Records of 192 patients who visited the Emergency department of Sangggye Paik Hospital. Inje University by the 119 EMS system from February 1 to February 28, 1998 were analyzed statistically according to the contents of record form. In conclusion, the new standardized rescue record form of the 119 EMS system was effective in giving information of patients' history and analysing of the 119 EMS system. But, Detailed modification of the record form about disease entities is needed for proper initial evaluation of emergency patient.
Emergencies* ; Emergency Service, Hospital ; Humans ; Jurisprudence ; Retrospective Studies*

BACKGROUND: The target of the treatment of metabolic syndrome and diabetes is an improvement of insulin resistance. D-chiro-inositol (DCI) plays a role in a phospholipid mediating intracellular insulin action. In the previous studies, the urine level of DCI were decreased in the diabetic animal with insulin resistance. Some clinical studies showed that DCI improved a glucose level and HbA1c. Therefore we studied the relationship between DCI and glucose metabolism, especially insulin resistance. METHODS: To investigate the mechanism of DCI affecting the glucose metabolism, we examined the effects of DCI on 2-deoxyglucose uptake, gene expression of adipocytokines and AMPK pathway by using RT-PCR and western blot in 3T3-L1 cells. RESULTS: Insulin-stimulated 2-deoxyglucose uptake increased in DCI-treated cells by about 1.2-fold (relative to the control) and was inhibited by phosphoinositide 3-kinase (PI3 Kinase) inhibitors (Wortmanin, LY294002) and AMPK inhibitor (STO-609). In Western blot analysis, it didn't show the difference of phosphorylation of Akt and AMPK between DCI-treated group and control in 3T3-L1 cells. However, DCI decreased the gene expression of resistin in 3T3-L1 cells. CONCLUSION: DCI may involve other pathway of insulin signaling, but not PI3 Kinase and AMPK signaling pathways and it may be useful in managing metabolic syndrome by improving insulin resistance through increasing glucose uptake and decreasing resistin relevant to insulin resistance.
3T3-L1 Cells ; Adipokines ; Animals ; Blotting, Western ; Deoxyglucose ; Gene Expression ; Glucose ; Insulin ; Insulin Resistance ; Negotiating ; Phosphorylation ; Phosphotransferases ; Resistin

BACKGROUND AND PURPOSE: We examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia. METHODS: We prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD). RESULTS: The PSQI global score was 6.25+/-3.88 (mean+/-SD) for the dementia caregivers and 5.47+/-3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality. CONCLUSIONS: Dementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.
Alzheimer Disease ; Apathy ; Appetite ; Caregivers* ; Dementia* ; Dementia, Vascular ; Depression ; Dihydroergotamine ; Humans ; Mild Cognitive Impairment* ; Neuropsychological Tests ; Prospective Studies ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Surveys and Questionnaires

It is controversial whether isolated lesions of mammillothalamic tract (MTT) produce significant amnesia. Since the MTT is small and adjacent to several important structures for memory, amnesia associated with isolated MTT infarction has been rarely reported. We report a patient who developed amnesia following an infarction of the left MTT that spared adjacent memory-related structures including the anterior thalamic nucleus. The patient s memory deficit was characterized by a severe anterograde encoding deficit and retrograde amnesia with a temporal gradient. In contrast, he did not show either frontal executive dysfunction or personality change that is frequently recognized in the anterior or medial thalamic lesion. We postulate that an amnesic syndrome can develop following discrete lesions of the MTT.
Aged ; Amnesia/*etiology ; Cerebral Infarction/*complications ; Humans ; Male ; Mamillary Bodies/*physiopathology ; Neuropsychological Tests ; Thalamus/*physiopathology