Ataxia is one of the most serious neurological symptoms in elderly The clarification of the related anatomical structures are necessary for the understanding of pathophysiologic mechanisms of ataxia. We have recently experienced a case of thalamic infarct in the territory of thalamogeniculate artery. The localization of lesion was based on CT and MR imaging. At first time, right hemiparesis and ataxia were prominent. Hemiparesis was transient but ataxia had been persistent for several months. It has been suspected that thalamus could be the part of neural circuits in balancing. Our case support this suggestion clinically. Based on clinical observations, a plausible extrapolation can be made to thalamic ataxia. It maybe related with dysfunction of dentatorubrothalamic and corticopontine pathway. Thus our case led us to conclude that thalamus could be engaged in balance control of human body.
Aged* ; Arteries ; Ataxia* ; Human Body ; Humans ; Magnetic Resonance Imaging ; Paresis ; Thalamus

No abstract available.
Giant Cell Tumors* ; Giant Cells* ; Spine*

We described 2 patients with Marchiafava-Bignami disease, a neurological disorder associated with chronic alcohol consumption. Patient 1 expressed general weakness and confusion, while patient 2 expressed dysphagia and seizures. Lesions involving the corpus callosum were identified with T2 weighted MR imaging in which there was a hyperintensity in the splenium of patient 1 and in the entire corpus callosum of patient 2. While the conditions of both patients were improved by with nutritional support, they were left with cognitive impairment.
Alcohol Drinking ; Corpus Callosum ; Deglutition Disorders ; Demyelinating Diseases ; Humans ; Magnetic Resonance Imaging ; Marchiafava-Bignami Disease* ; Nervous System Diseases ; Nutritional Support ; Seizures

PURPOSE: Mycophenolate mofetil (MMF) is thought to have not only low frequency of adverse side effects but also have equal efficacy to other conventional immunosuppressants (CIS). But It's hard to conclude that CIS may be replaceable with MMF. So we inquired into another aspect of MMF as 'Rescue therapy' in non-transplant renal diseases. METHODS: Twenty nine patients with non-transplant renal diseases received MMF therapy between January 2000 and April 2007. Eighteen patients who had received MMF more than 6 months were included. Sixteen of the 18 patients included were resistant to CIS and two were patients who maintained complete remission (CR) with MMF because of the adverse side effects of CIS. Treatment outcome was evaluated by dip-stick urine test. CR was defined by negative or trace, partial remission (PR) by 1 positive and treatment failure (TF) by more than 1 positive. RESULTS: Eleven of the resistant 16 patients had shown CR (69%) and maintained CR. Two of maintenance therapy with MMF had kept CR more than 12 months. The proportions of the patients who had shown decreased proteinuria in each treatment duration were 69% for 3 months (p=0.005), 81% for 6 months (p=0.001), 86% for 9 months (p=0.002) and 91% for 12 months (p=0.004), respectively. There were few adverse effects. CONCLUSION: We observed the efficacy of MMF in decreasing proteinuria and maintaining CR as 'Rescue therapy' for previously treated non-transplant renal disease patients with CIS. Large controlled clinical trials are expected for defining this effect.
Humans ; Immunosuppressive Agents ; Kidney Diseases ; Mycophenolic Acid ; Proteinuria ; Treatment Failure ; Treatment Outcome

Rhabdomyomas are rare benign tumors. Most extracardiac rhabdomyomas are found in the head and neck region, especially in the pharynx and larynx. Herein, we have described the case of a 1-year-old boy presenting with recurrent otorrhea and postauricular swelling. His symptoms were due to a mass that was histologically diagnosed as fetal rhabdomyoma (FR). Here, we report the first case of FR in the postauricular area. Clinicians should keep in mind the possibility of FR if a child presents with external auditory canal mass associated with recurrent otorrhea and signs of mastoiditis.

A 12-year-old intact male Dalmatian dog presented hyporexia and vomiting for 1 week. Blood analysis revealed increased liver enzyme activity. Histopathological examination of the liver confirmed chronic hepatitis with fibrosis and necrosis. Copper staining revealed marked copper accumulation (2,770 ppm; normal range, 200 to 400 ppm), prominent in the centrilobular region, and compatible with copper-associated chronic hepatitis. However, copper metabolism domain containing 1 (COMMD1) mutation predisposing to copper accumulation in the liver tissue was not identified. The dog received medications but died 1 month after first visit. This is the first case of primary copper-associated hepatitis without COMMD1 mutation in a Dalmatian dog in South Korea.

PURPOSE: Radio-guided sentinel node biopsy has become a standard method for evaluating the axillary status. However, there is no guideline for the optimum extent of sentinel lymphadenectomy. The object of this study was to assess the probability of metastases according to the sequence of radioactivity in the sentinel nodes and to determine the accuracy of the methods for evaluating metastases. METHODS: 80 consenting patients underwent sentinel lymph node biopsy using 99mTc-phytate. All the lymph nodes that showed radioactivity higher than surroundings were excised and labeled as SN1 to SN5 according to the sequential radioactivity. All the excised sentinel nodes were evaluated by frozen sectioning (FS) and permanent sectioning (PS). The sensitivity, specificity, negative predictive value and accuracy of the procedure were then analyzed according to the evaluation method. RESULTS: All 80 patients showed a variable number of axillary sentinel node sites (SN1-SN5) and 19 patients (23.8%) had three or more sentinel node sites, with an average number of 1.98. The sensitivity, specificity, NPV and accuracy were higher on PS (94.4%, 100%, 98.4% and 98.8% respectively) than on FS (88.9%, 100%, 96.9% and 97.5% respectively). 20 patients were found to have metastatic breast cancer within the sentinel lymph nodes by IHC, but one case of a metastatic, non-sentinel node was found in the 60 patients with negative sentinel nodes, so that the final false negative rate was 4.8%. In 18 of the 20 sentinel node-positive patients(90.0%), the most radioactive lymph node (SN1) was a positive node. The removal of the most radioactive sentinel node and the 2nd most radioactive sentinel node accurately staged all 20 sentinel node-positive patients. CONCLUSION: Careful evaluation of the sentinel nodes with FS, PS and IHC study is essential to reduce the false negative results. In addition, excision of the highest and the 2nd highest lymph nodes is essential and the excision of the 3rd highest node if any, should also be considered for obtaining a better treatment results.
Biopsy* ; Breast Neoplasms* ; Breast* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Radioactivity* ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy

BACKGROUND: Despite using renin-angiotensin system (RAS) blockades, some of the patients with immunoglobulin A (IgA) nephropathy often had persistent proteinuria of more than 500mg/d. They need to be managed further by alternative methods to halt the progression of the disease; these methods could also be applied safely over a long period of time. In this context, sulodexide has been studied for the management of diabetic nephropathy. METHODS: A retrospective review was carried out involving 20 patients with IgA nephropathy who had been taking sulodexide (50mg daily) as an add-on therapy together with an optimal dose of RAS blockades during 2008-2009. We evaluated the proteinuria reduction rates and renal function changes. RESULTS: During 11.1+/-72.7 months of follow-up duration, urinary protein-to-creatinine ratio (UPCR) decreased for 1.57+/-0.6 to 1.17+/-0.7 g/g (P=0.032). Twenty-five percent of the patients showed a greater than 50% reduction of UPCR, and 40% had a UPCR of less than 1.0g/g at their final observations. The analysis of the factors contributing to the effect found that a higher pretreatment UPCR showed a significant correlation with the UPCR decrease (r=0.45, P=0.047). Neither the adverse effects nor the renal function impairments were documented during the management. CONCLUSION: Low-dose sulodexide has an additional modest antiproteinuric effect on IgA nephropathy undergoing RAS blockade therapy.
Follow-Up Studies ; Glomerulonephritis, IGA ; Glycosaminoglycans ; Humans ; Immunoglobulin A ; Proteinuria ; Renin-Angiotensin System ; Retrospective Studies

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.
Aged ; Duodenal Diseases/complications/radiography/*surgery ; Female ; Humans ; Hydronephrosis/complications/radiography ; Intestinal Fistula/complications/radiography/*surgery ; Kidney/radiography/surgery ; Kidney Calculi/complications/radiography ; Kidney Diseases/complications/radiography/*surgery ; Ligation ; Urethral Obstruction/complications/radiography ; Urinary Fistula/complications/radiography/*surgery ; Urinary Tract Infections/complications/radiography

PURPOSE: This study was performed to demonstrate a correlation among urinary 15d-PGJ2, proinflammatory cytokines (i.e. IL-23, IL-6, and TGF-beta1), and CRP, and to determinate the contributors to prognostic score and proteinuria in IgAN patients. METHODS: Fifty-four patients with biopsy-proven IgAN were enrolled. For comparison with IgAN, five MCD patients were also enrolled. Immunohistochemical staining for PPAR-gamma in kidney tissue and measurements of urinary IL-6, IL-23, TGF-beta1, 15d-PGJ2 and serum CRP were performed RESULTS: There was no difference according to PPAR-gamma staining. 15d-PGJ2 was negatively correlated with urinary IL-23, TGF-beta1, and CRP. Among proinflammatory cytokines and CRP, there were positive relationships with each other except for IL-23 and CRP. TGF-beta1 in the group having proteinuria more than 3 g/day was statistically higher than that in the sole hematuria group. However, in multivariate regression analysis, not a single relation was found between TGF-beta1 and proteinuria. Prognostic score was correlated with IL-6, IL-23, TGF-beta1, CRP, 15d-PGJ2, and 24hr proteinuria. 24hr proteinuria was correlated with IL-6 and 15d-PGJ2. In multivariate regression analysis, CRP, 15d-PGJ2, and 24hr proteinuria contributed to prognostic score, and only 15d-PGJ2 contributed to 24hr proteinuria. Last, urinary 15d-PGJ2 in IgAN was higher than that in MCD. CONCLUSION: Endogenous 15d-PGJ2 was associated with inflammation and might be considered as a material which could delay the damage of kidney in IgAN. In the future, larger cohort and long-term follow-up studies are needed to demonstrate the role of 15d-PGJ2 as prognostic indicator or marker of kidney damage.
Cohort Studies ; Corneal Dystrophies, Hereditary ; Cytokines ; Follow-Up Studies ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Inflammation ; Interleukin-23 ; Interleukin-6 ; Kidney ; Prostaglandin D2 ; Proteinuria ; Transforming Growth Factor beta1