BACKGROUND AND OBJECTIVE: Transient global amnesia(TGA) is a neurological syndrome affecting preferentially middle-aged or elderly people and characterized by sudden onset of transient impairment of antegrade amnesia with variably retrograde amnesia. TGA was defined over 30 years ago, but the etiology remain unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks in both posterior cerebral artery territories, epilepsy, and migraine. Although many studies have reported TGA, only a few reported cerebral perfusion studies using SPECT because of the brief duration of the episode. Technetium-99m-ethyl cysteinate dimmer(ECD) is superior to sensitivity of lesion detection and lesion to normal contrast, probably due to lower back diffusion from the brain to the blood and its excellent radiochemical stability. So we evaluate pathophysiologic mechanism of TGA by using 99mTC-ECD SPECT with or without acetazolamide(ACZ) stress. METHODS: We evaluated six patients with transient global amnesia, four women and two men, age ranges 56 to 78 years, mean 62.2 years. Measurements of CBF and vascular reserve using 99mTC-ECD with or without ACD stress were performed during or after TGA episode. RESULTS: One patient, who was evaluated in TGA episode showed that regional cerebral blood flow was decreased in both anteroinferior frontal, both temporal, right thalamus, both inferior parietal and left parietal region with impaired vascular reserve in left inferior temporal and right thalamus. Others, who were evaluated more than 6days in TGA episode showed that regional cerebral blood flow was decreased in left temporal (4), both temporal region (1), left thalamus (2) and both basal ganglia (1) with preserved vascular reserve except one, showed impaired vascular reserve in left thalamus. CONCLUSION: This result show that severe hypoperfusion of bilateral temporal region and impaired vascular reserve in left temporal region in TGA episode. Other patients who were recovered from TGA showed hypoperfusion of left temporal region and preserved vascular reserve. 99mTc-ECD with acetazolamide SEPCT that sensitively detects localized impaired cerebraovascular reserve should help elucidate these processes. But further study with more cases is necessary for evaluation of pathophysiology of TGA.
Acetazolamide ; Aged ; Amnesia ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Basal Ganglia ; Brain ; Diffusion ; Epilepsy ; Female ; Humans ; Male ; Migraine Disorders ; Perfusion ; Posterior Cerebral Artery ; Rabeprazole ; Technetium* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: From February 1995 to April 1998, those patients who had visited for evaluation of infertility, shown abnormal endometrial pattern on hysterosalpingography underwent resectoscopic operation. We evaluated about its therapeutic effect, recurrence rate of uterine adhesion and effectiveness of its assisted method. METHOD: We have reviewed 45 cases of intrauterine adhesion, classified as a central type, marginal type and multiple type. We used 26F resectoscope made in Storz for operation and inserted Lippes loop or pediatric foley catheter for prevention of readhesion. For promoting reepithelialization, conjugated estrogens(premarin) 5mg daily for 30 - 50 days were given and then 10mg of medroxyprogesterone acetate(provera) were added daily for the last 10 days. We evaluated the uterine cavity condition preoperatively and postoperatively by using hysterosalpingography. RESULT: In 45 cases, 41 cases were followed up postoperatively. 21 cases were markedly improved, 12 cases were improved and 8 cases were not improved or recurred on hysterosalpingography. In 41 cases, for prevention of readhesion 20 cases were used pediatric foley catheter and 5 cases(25%) were recurred. 21 cases were used Lippes loop and 3 cases(14%) were recurred. Pregnancy outcome was as follows;15 cases were pregnant and 10 cases delivered a viable infant, 3 cases aborted spontaneously, 1 case was ectopic pregnancy and laparoscopic salpingectomy was done, 1 case was ongoing pregnancy. CONCLUSION: This report suggests that resectoscopic operation is very effective in the treatment of intrauterine adhesion(therapeutic rate of 81%) and that the use of Lippes loop seems like to have the less recurrence rate than the use of pediatric foley catheter in prevention of postoperative readhesion, but more experience and further follow-up are necessary to obtain more detailed conclusions.
Catheters ; Female ; Follow-Up Studies ; Humans ; Hysterosalpingography ; Infant ; Infertility ; Medroxyprogesterone ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Recurrence ; Salpingectomy

BACKGROUND AND PURPOSE: Congenital nystagmus (CN) is an ocular oscillation that usually manifests during early infancy. Typical features of CN include bilateral, conjugate, uniplanar, and usually horizontal eye movements, a null position, increased oscillation during fixation, and decreased amplitude during convergence. Our purposes were description and analysis of clinical and oculomotor findings of patients with X-linked familial CN. METHODS: We describe the clinical and oculographic features of five patients from three families with X-linked CN. Three-dimensional video-oculography disclosed various patterns of CN and variable degrees of gaze-holding deficits and visual impairments. RESULTS: The features of CN varied even in patients from the same family. Head tilt, strabismus, reversal of optokinetic nystagmus, and impairments of the vestibulo-ocular reflex, smooth pursuits, and saccades were frequent findings. CONCLUSIONS: The intra- and interfamilial diversities imply that heredity plays a secondary role in determining the clinical phenotypes and waveforms of CN.
Eye Movements ; Head ; Heredity ; Humans ; Nystagmus, Congenital* ; Nystagmus, Optokinetic ; Phenotype ; Pursuit, Smooth ; Reflex, Vestibulo-Ocular ; Saccades ; Strabismus ; Vision Disorders

BACKGROUND AND PURPOSE: Congenital nystagmus (CN) is an ocular oscillation that usually manifests during early infancy. Typical features of CN include bilateral, conjugate, uniplanar, and usually horizontal eye movements, a null position, increased oscillation during fixation, and decreased amplitude during convergence. Our purposes were description and analysis of clinical and oculomotor findings of patients with X-linked familial CN. METHODS: We describe the clinical and oculographic features of five patients from three families with X-linked CN. Three-dimensional video-oculography disclosed various patterns of CN and variable degrees of gaze-holding deficits and visual impairments. RESULTS: The features of CN varied even in patients from the same family. Head tilt, strabismus, reversal of optokinetic nystagmus, and impairments of the vestibulo-ocular reflex, smooth pursuits, and saccades were frequent findings. CONCLUSIONS: The intra- and interfamilial diversities imply that heredity plays a secondary role in determining the clinical phenotypes and waveforms of CN.
Eye Movements ; Head ; Heredity ; Humans ; Nystagmus, Congenital* ; Nystagmus, Optokinetic ; Phenotype ; Pursuit, Smooth ; Reflex, Vestibulo-Ocular ; Saccades ; Strabismus ; Vision Disorders

The present case first describes the spontaneous thigh hematoma induced by enoxaparin in a hemodialysis patient. A 64- year-old woman on a hemodialysis therapy was diagnosed with acute coronary syndrome, and treated with enoxaparin. Ten days after enoxaparin administration, diffuse swelling and pain developed suddenly in the right thigh without a history of trauma. There was a weak arterial pulse below the knee with an abrupt decrease of hemoglobin level. There were no significant abnormalities in the coagulation tests including the platelet count, prothrombin time, and activated partial thromboplastin time. Computed tomographic (CT) angiography and lower extremity arteriography were performed, which showed several bleeding foci involving branches of the right deep femoral artery. She was treated successfully by embolization at the bleeding sites, along with a transfusion.
Acute Coronary Syndrome ; Angiography ; Enoxaparin ; Female ; Femoral Artery ; Hematoma ; Hemoglobins ; Hemorrhage ; Humans ; Knee ; Lower Extremity ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Renal Dialysis ; Thigh

This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam Province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: 38.9~44.6%%, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.l%), injury and poisoning(7.l%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.
Cause of Death ; Certification ; Classification ; Insurance ; Jeollanam-do ; Poisoning

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992 METHODS: Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992 RESULTS: 1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure. CONCLUSIONS: The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.
Adult ; Ankle ; Cardiology ; Child ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Elbow ; Electrocardiography ; Hand ; Heart ; Heart Failure ; Hip ; Humans ; Incidence ; Inpatients ; Joints ; Knee ; Korea ; Myocarditis ; North America ; Rheumatic Fever* ; Rheumatic Heart Disease ; Seasons ; Shock, Septic ; Streptococcal Infections

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992 METHODS: Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992 RESULTS: 1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure. CONCLUSIONS: The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.
Adult ; Ankle ; Cardiology ; Child ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Elbow ; Electrocardiography ; Hand ; Heart ; Heart Failure ; Hip ; Humans ; Incidence ; Inpatients ; Joints ; Knee ; Korea ; Myocarditis ; North America ; Rheumatic Fever* ; Rheumatic Heart Disease ; Seasons ; Shock, Septic ; Streptococcal Infections

The peripherally inserted central catheter (PICC) is used frequently in preterm infants. The known complications associated with the PICC include infection, thrombosis, extravasation, phlebitis, leakage of insertion site, fracture, accidental removal, occlusion of the PICC, and arrhythmia. We herein report a case of a spontaneously fractured PICC remnant that was successfully removed by cardiac catheterization.
Arrhythmias, Cardiac ; Cardiac Catheterization* ; Cardiac Catheters* ; Catheters* ; Humans ; Infant, Newborn ; Infant, Premature* ; Phlebitis ; Thrombosis

In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System (SynchronyTM, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were 11.5+/-3.09 mm for desynchronization and 0.14+/-0.08 mm for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was 0.18+/-0.06 mm. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was 17.39+/-0.14 mm for inactivity and 1.37+/-0.11 mm for activity. The mean difference of absolute dose was 0.68+/-0.38% in static target and 1.31+/-0.81% in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.
Four-Dimensional Computed Tomography ; Prescriptions ; Radiosurgery ; Track and Field