Hypnic headache is a unique headache disorder that occurs exclusively during sleep and often with "alarm-clock" consistency. It is a rare, benign, moderately severe, enduring headache syndrome that occurs in middle-aged to elderly adults and affects both sexes. The pathophysiology of hypnic headache is unknown, but its circardian periodicity and responsiveness to lithium suggest chronobiologic sleep disturbance contributing to the genesis of hypnic headache. We have recently experienced 2 cases of hypnic headache. They showed the characteristic signs of hypnic headache. We present our cases and discuss the pathophysiology of hypnic headache.
Adult ; Aged ; Headache Disorders ; Headache Disorders, Primary* ; Humans ; Lithium ; Periodicity

Hyperthyroidism is a well known cause of atrial fibrillation. It is also known that control of hyperthyroidism can usually curb thyrotoxic atrial fibrillation and restore sinus rhythm. In this study, 282 patients with hyperthyroidism were investigated to quantify the incidence of atrial fibrillation, and to identify the vulnerable groups. In addition, we compared two groups of subjects with atrial fibrillation-one group with hyperthyroidism and the other group without
Aged ; Atrial Fibrillation ; Female ; Follow-Up Studies ; Heart Diseases ; Humans ; Hyperthyroidism ; Incidence ; Male ; Sex Ratio ; Thyroid Gland

Intracranial tuberculoma results from hematogenous spread of pulmonary, intestinal or urogenital tuberculosis. However, it might be caused by pulmonary tuberculosis, mainly. Clinically, symptoms of intracranial tuberculoma are headache and seizure, its symptoms are simillar to intracranial tumor. A 25-year-old-unmarried shopgirl was visited to this hospital because of headache, dizziness and visual disturbance for couple weeks in Sep. 1995. She had been treated with anti-tuberculosis agents of miliary tuberculosis during past nine months period. Brain MRI revealed intracranial tuberculoma and brain edema but not involved optic nerve. Ophthalmic examination revealed severe papilledema and splinter hemorrhage with bitemporal hemianopsis and central scotoma. This finding was strongly suggested of optic disc tuberculoma. Her symptoms became much better following repeated retrobulbar steroid injection with continuous anti-tuberculosis agents. We report a interesting case with intracranial tuberculoma and optic disc tuberculoma associated by miliary tuberculosis during anti-tuberculous treatment.
Brain ; Brain Edema ; Dizziness ; Headache ; Hemorrhage ; Magnetic Resonance Imaging ; Optic Nerve ; Papilledema ; Scotoma ; Seizures ; Tuberculoma* ; Tuberculoma, Intracranial* ; Tuberculosis, Miliary* ; Tuberculosis, Pulmonary ; Tuberculosis, Urogenital

PURPOSE: We aimed to know the prevalence of abnormal meniscal signal on MR imaging in asymptomatic soccer players and its radiologic significance. MATERIALS AND METHODS: Using T1 and gradient echo T2* weighted sagittal and coronal MR image, 48 knees in twenty-four full time soccer players were evaluated for the meniscal abnormalities, the status of ligament and existance of joint effusion. Meniscal abnormalities were interpretated using grading system of Lotysch. By using Chi-square method, We analyzed the existance of joint effusion could divide the healing state and healed state of the meniscus. RESULTS: The prevalence of Grade 2 and more and Grade 3 were 42% and 39% of asymptomatic knees. In the 24 knees with meniscus tear, nine of the 14 asymptomatic knee showed effusion while eight of the 10 symptomatic knee did. Of 24 knees with meniscal tear, only eleven knees were related to previous history of major knee trauma. CONCLUSIONS: The prevalence of meniscal abnormalities on MR imaging in asymptomatic soccer players was higher(grade 3:39%) than we expected. The joint effusion was not helpful to divide the healing state and healed state of the meniscus. So we suggest baseline MR imaging in the athletes who have been using the knee vigorously could give decisive information for the interpretation of subsequent MRI that may be performed when the players wounded.
Athletes ; Humans ; Joints ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Prevalence* ; Soccer* ; Wounds and Injuries

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of [18F]FDG PET in the diagnosis of recurrent head and neck cancer after the completion of surgery and radiotherapy in patients with head and neck cancers. MATERIALS AND METHODS: In fifty-nine patients with head and neck cancers, whole body [18F]FDG PET studies were performed. According to the different therapeutic modalities, patients were divided into four groups (Group I; pre-treatment, Group II; surgery, Group III; radiotherapy, Group IV; both surgery and radiotherapy). [18F]FDG PET images were compared with clinical, CT and histopathologic findings. RESULTS: For detection of metastatic lymph nodes in 14 patients of pre-treatment group (group I), the sensitivity and specificity of PET were 100% (10/10) and 75% (3/4), and those of CT were 80% (8/10) and 100% (4/4). For detection of recurrence in 45 patients of post-treatment group, overall sensitivity and specificity of PET were 96.2% (25/26) and 78.9% (15/19) [(100% and 75% in group II, 80% and 50% in group III, and 100% and 100% in group IV)] without significant difference from pre-treatment group (p>0.1). In detecting recurrence, the sensitivity and specificity of [18F]FDG PET were 90.9% (10/11) and 20% (1/5) in 16 patients who underwent [18F]FDG PET within 2 months after the completion of treatment. The specificity of these patients was significantly lower than that of 29 patients (100% of sensitivity and specificity) who underwent [18F]FDG PET 2 months after treatment (p<0.05). CONCLUSION: [18F]FDG PET is an accurate diagnostic modality for the detection of recurrence in head and neck cancer. Post-therapy [18F]FDG PET should be obtained at least 2 months after the completion of surgery or radiotherapy.
Diagnosis ; Head and Neck Neoplasms ; Head* ; Humans ; Lymph Nodes ; Neck* ; Radiotherapy* ; Recurrence ; Sensitivity and Specificity

The authors reviewed the radiographs and medical records of 134 consecutive patients who underwent chemonucleolysis and automated percutaneous lumbar discectomy(APLD) between March 1990 and December 1994 at our institute. Among the 34 consecutive patients, 90 patients underwent chemonucleolysis and the other remaining patients underwent APLD using a nucleotome. The results are summarized as follows: 1) In both groups, predominent patients were of young age and males. 2) The most common lesion was in L4-5 interspace in both groups 3) The posteior lateral type showed high incidence in APLD group. 4) The results were better in the younger age group and when spinal CT demonstrated posterior lateral type in both groups. 5) The results showed relatively good success rate of 84.4% in chemonucleolysis group and 88.6% in APLD group. 6) Better results can be anticipated when patients are carefully selected and operated on with a higher skillful technique.
Diskectomy* ; Humans ; Incidence ; Intervertebral Disc Chemolysis ; Male ; Medical Records ; Spine*

Thoracopagus is very rare congenital anomaly with an incidence estimated at 1 in 50,000 deliveries or 1 in 600 twin deliveries. If twining is initiated after the embryonic disc and the rudimentary amnionic sac have been formed, and if division of the embryonic disc is incomplete, conjoined twins result. We experienced a case of thoracopagus in 28 years old woman. We present this case with a brief review of literatures.
Adult ; Amnion ; Female ; Humans ; Incidence ; Twins, Conjoined

PURPOSE: Adverse reactions to mosquito bites have been recognized for some time, and these usually consist of large swellings, generalized urticaria, angioedema, and less frequently asthma. There have been some efforts to define immunologic characteristics of mosquito allergens throughout the world. But, in Korea, the immunologic analysis of mosquito allergen have not been made. METHODS: Extracts of locally distributed female mosquito Culex pipiens, were prepared from their heads and thoraxes. By sodium dodecylsulfate-polyacrylamide gel electrophoresis, proteins of two extracts were isolated. Then their proein bands were transferred to nitrocellulose membrane. Immunoblotting was performed with sera of allergic patients to mosquito bites, then completed by antibodies to human IgE. RESULTS: Immunoblotting showed IgE binding proteins weighing 70 kD, 60 kD, 34 kD in Culex pipiens. CONCLUSION: We found that mosquito antigens induced IgE response, and it suggested that species-specific antigens exist. Further investigation using salivary gland extracts from Culex genus are needed in identifying specific allergens.
Allergens* ; Angioedema ; Antibodies ; Asthma ; Collodion ; Culex* ; Culicidae* ; Electrophoresis ; Female ; Galectin 3 ; Head ; Humans ; Immunoblotting ; Immunoglobulin E ; Korea ; Membranes ; Salivary Glands ; Sodium ; Thorax ; Urticaria

PURPOSE: Cockroaches have been reported one of the major causes of allergic disease such as bronchial asthma and allergic rhinitis. About 10% of children and 20% of adult respiratory allergy patients have positive results of allergy skin tests to cockroach allergen. This finding suggests that cockroach is also important allergen in Korea. Among 4,000 species, German cockroach seems predominant species in the Korean peninsula. Identification and charactrerization of the major allergen is the first step in German cockroach allergen research. But, there have been controversies. It may depends upon different identifying methods. The aim of our study was to identify the major allergen in German cockroach using Westernblot. METHODS: Crude German cockroach allergen extracts with or without protease inhibitor cocktail mixture were prepared, and protein patterns of these two extracts were compared using SDS-PAGE and Coommssie stain. Sera from 32 atopic asthmatic patients with positive allergy skin test against cockroach allergen were used for IgE immunoblot. RESULTS: Coomassie stain after SDS-PAGE demonstrated some discordance between the differently prepared crude allergen extracts. In comparison with the allergen extract which abolished endogenous protease activity, the untreated extract revealed new 32, 55 and 78 kD protein bands and 41 kD protein band was disappeared. About 60% of sera with positive allergy skin test revealed IgE binding bands in Westernblot. Among them, 10, 21, 25, 36 and 52 kD protein band might seemed important German cockroach allergen. CONCLUSION: Finding above may suggest that endogenous protease could denature allergenic proteins in the process of crude cockroach allergen extract. The 10, 21, 25, 36, and 52 kD might be the important allergens in German cockroach.
Adult ; Allergens ; Asthma ; Blattellidae* ; Child ; Cockroaches ; Electrophoresis, Polyacrylamide Gel ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Protease Inhibitors ; Rhinitis ; Skin Tests

Multiple primary malignant neoplasms (MPMN) are defined by the presence of multiple primary cancers of multicentric origin and/or different tissues. The incidence of MPMN is less than 1% in Korea and recently seems to be increased due to early detection of cancer and prolonged survival of cancer patients. Previous investigations suggest that non-Hodgkin's lymphoma (NHL) may be associated with chronic liver disease and hepatocellular carcinoma (HCC). The pathogenesis of this association is thought to be due to chronic antigenic stimulation, the presence of HBsAg, and immunosuppressive therapy. We report a case of synchronous NHL and HCC in a 54-year-old man which is thought to be associated with hepatitis B virus infection. Pathological examination and immunohistochemical study of neck lymph node and liver mass biopsies showed diffuse large cell lymphoma and HCC, respectively. He was treated initially with EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide and prednisolone) chemotherapy for NHL and transarterial chemoembolization with doxorubicin, mitomycin-c, lipiodol, and gelfoam for HCC.
Biopsy ; Carcinoma, Hepatocellular* ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Early Detection of Cancer ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Incidence ; Korea ; Liver ; Liver Diseases ; Lymph Nodes ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin* ; Middle Aged ; Mitomycin ; Neck ; Vincristine