The knowledge about nutritional, toxic, and metabolic causes of dementia is particularly important, because they may be reversible. Central pontine myelinolysis(CPM) is one of these causes. CPM is a well known but rare metabolic disease of unknown etiology linked to overly aggressive correction of hyponatremia. We report a 74-year-old woman who developed disorientation, memory disturbance, and behavioral problem following intensive care unit management for pneumonia. Mini-mental status examination-Korean version(MMSE-K) study revealed severe cognitive dysfunction. Brain magnetic resonance imaging showed changes consistent with CPM and extrapontine myelinolysis. After supportive care, patient's clinical status was significantly improved. We suggest that a metabolic problem such as CPM should be considered in the diagnosis of acute or subacute cognitive deterioration in elderly patients.
Aged ; Brain ; Dementia ; Diagnosis ; Female ; Humans ; Hyponatremia ; Intensive Care Units ; Magnetic Resonance Imaging ; Memory ; Metabolic Diseases ; Myelinolysis, Central Pontine* ; Pneumonia ; Problem Behavior

No abstract available.
Haloperidol* ; Humans*

No abstract available.
Aged* ; Humans ; Peripheral Nervous System Diseases*

No abstract available.
Decompression* ; Intestinal Obstruction*

BACKGROUND: Drug-induced Parkinsonism(DIP) is the second commonest cause of Parkinsonism, after idiopathic Parkinson's disease(IPD). DIP is frequently produced by antipsychotic drugs. But the clinical characteristics of DIP did not get attention by neurologist. So we studied the clinical profiles of DIP patients. METHODS: We studied the clinical profiles of thirthone patients who showed parkinsonism after antipsychotic drug treatment. We compared the score of motor part of the Unified Parkinson's Disease Rating Scale(UPDRS) between trihexyphenidyl(n=15) & amantadine(n=16) monotherapy group(initial & 4 week after treatment). RESULTS: The mean age of patients was 45 years. Bradykinesia was the 1st symptom in 26 patients(94%), tremor in 5 patients(6%). In 25 patients(81%), the first symptom appeared within 1 week after sntipsychotic treatment. There was a statistical significant negative correlation between the dosage of antipsychotic drug and the symptom-onset interval following treatment with antipsychotic drugs(simple correlation analysis, p>0.01). Bradykinesia and rigidity were appeared in all DIP patients, symmetric distribution was more common(94%, 87%) Tremor occurred in 27 patients (87%). In patients with tremor, postural or action tremor was dominant in 15 patients(56%) asymmetric distribution was more common(16/27, 59%). There are no statistical difference in motor score of UPDRS between trihexyphenidyl & amantadine monotherapy group(student t-test, p<0.05) CONCLUSIONS: Bradykinesia was the most common 1st symptom in DIP patients. Asymmertrical postural or action tremor was relativelly common in DIP. Amantadine showed the same efficacy in the treatment of DIP compared to anticholinergics.
Amantadine ; Antipsychotic Agents ; Cholinergic Antagonists ; Humans ; Hypokinesia ; Parkinson Disease ; Parkinsonian Disorders* ; Tremor ; Trihexyphenidyl

BACKGROUND AND PURPOSE: Neurotrophic factors has been a subject of interest in the research of Parkinson's disease. In this experiment, intrastriatal 6-Hydroxydopamine(6-OHDA) injection was used to observe the effect of dopaminergic deafferentiation on the neurotrophic factor mRNA expression in the rat brain. METHODS: Male Sprague Dawley rats (250~300 gm) were treated to produce specific unilateral dopaminergic deafferentiation via injection of 6-OHDA at the right striatum without effect on the noradrenergic system. Treatment group (N=20) received same volume of vitamin C at the same site. The rats were sacrificed 3 hours, 12 hours, 24 hours, 3 days, 1 week, 2 weeks, 3 weeks, 4 weeks, after injection. The expression of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), tyrosine hydroxylase (TH), and enkephalin (ENK) mRNA were observed by in situ hybridization histochemistry in the hippocampus, striatum and substantia nigra. RESULTS: The expression of BDNF mRNA was increased in the cerebral cortex, dentate gyrus, and hippocampus. In the cerebral cortex, the increase of expression was peaked at 12 hours after 6-OHDA injection and confined to injection side. In the dentate gyrus, the expression was significantly increased in the injection side at 12 hours after injection, after that increased expression was observed in both side. The expression of NGF mRNA was increased in the dentate gyrus and cerebral cortex of lesion side at 3 hours and 12 hours after 6-OHDA injection. However, the expression of NT-3 mRNA was not changed. The expression of TH mRNA was gradually decreased in the substantia nigra compacta of injection side from 1 week to 4 weeks after 6-OHDA injection. The expression of enkephalin mRNA was increased from 24 hours, peaked at 1week, and returned to basal level at 4 weeks after injection in the injection side. CONCLUSION: From this results, it may suggest that the expression of neurotrophic factors in the cerebral cortex, dentate gyrus and hippocampus are closely related with the degeneration of dopaminergic neurons, not with the degeneration of noradrenergic neurons.
Adrenergic Neurons ; Animals ; Ascorbic Acid ; Brain* ; Brain-Derived Neurotrophic Factor ; Cerebral Cortex ; Dentate Gyrus ; Dopaminergic Neurons ; Enkephalins ; Hippocampus ; Humans ; In Situ Hybridization ; Male ; Nerve Growth Factor ; Nerve Growth Factors* ; Oxidopamine* ; Parkinson Disease ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Substantia Nigra ; Tyrosine 3-Monooxygenase

PURPOSE: Tension-free hernioplasty has become the most popular procedure for the repair of groin hernias in the United States and United Kingdom. The purpose of this study is to describe a 7-year personal experience with Lichtenstein's tension-free groin hernia repair under local anesthesia. METHODS: We retrospectively studied the clinical outcome of 321 cases of Lichtenstein repairs, performed consecutively by an experienced surgeon between Jan. 1994 and Dec. 2000. RESULTS: Of the 321 cases, 242 (75.4%) were indirect, 34 (10.6%) were direct, 8 (2.5%) were femoral, 7 (2.2%) were pantaloon, and 30 (9.3%) were recurred hernias. The mean age was 55 years; 91% were male. The mean number of injections of analgesics required in the postoperative period was 3.2. The mean hospital stay following repair was 2.7 days. Complications occurred in 23 cases (7.1%). Most of these were minor, consisting of five cases of bruising or hematomas (1.6%), four superficial infections (1.3%), three seromas (0.9%), two hydroceles (0.6%), six patients with persisting groin pain for more than a month (1.8%), one foreign body granuloma, one urinary retention, and one testicular atrophy. There were no recurrences or operative deaths. CONCLUSION: Lichtenstein's tension-free hernioplasty is an easy and simple technique with less pain, minor complications and only rare instances of recurrence. This procedure can be performed on a same-day basis under local anesthesia. Lichtenstein repair may be the most promising technique for the repair of groin hernias.
Analgesics ; Anesthesia, Local ; Atrophy ; Granuloma, Foreign-Body ; Great Britain ; Groin* ; Hematoma ; Hernia* ; Herniorrhaphy ; Humans ; Length of Stay ; Male ; Postoperative Period ; Recurrence ; Retrospective Studies ; Seroma ; United States ; Urinary Retention

The paraproteinemia is a disorder in which a single clone of plasma cells (monoclonal gammopathy) is responsible for the proliferation of monoclonal proteins (M-proteins). Approximately 10% of patients with idiopathic peripheral neuropathy have monoclonal gammopathy. Some M-proteins have the properties of an antibody to the components of peripheral nerve myelin, but the pathophysiological relationship between the neuropathy and the M-protein is often obscure. The relationship between peripheral neuropathy and monoclonal gammopathy requires the appropriate neurological and hematological investigations for precise diagnosis and treatment. In this review, we provide an update on the causal associations between peripheral neuropathy and monoclonal gammopathy as well as characteristics of clinical and electrophysiologic features.
Clone Cells ; Diagnosis ; Humans ; Myelin Sheath ; Paraproteinemias ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Plasma Cells ; Polyneuropathies

Huntington's disease is an autosomal dominant neurodegenerative disorder that usually begins in mid-life and is characterized by a progression of involuntary choreiform movements, personality change, and dementia. 4 specific unstable trinucleotide (CAG) repeat expansion in a gene on the short arm of chromosome 4 was recently identified as the pathogenic mutation for this disease. We have analysed the CAG expansion in peripheral leukocyte from a woman suspected with Huntington's disease and her family. A 40-year-old woman visited for the 6 years history of progressing intractable involuntary hyperkinetic movement and antagonistic personality. She showed bilateral caudate nucleus atrophy with mild enlargement of both frontal horn at brain MRI and showed the decrement of glucose metabolism in both basal ganglia at 18F-FDG PET scan. We also studied about the clinical manifestations of her family. Her younger brother also showed mild cognitive impairment and dysarthria. She and her relatives (n = 6) were tested for the existence of high risk allele of Huntington's disease by polymerase chain reaction method. The high risk allele (above 40 CAG repeat) in the 1715 gene was confirmed in 6 persons including the patient. The CAG repeat variance was 46 to 54. Only one person showed the normal range of CAG repeat.
Adult ; Alleles ; Animals ; Arm ; Atrophy ; Basal Ganglia ; Brain ; Caudate Nucleus ; Chorea ; Chromosomes, Human, Pair 4 ; Dementia ; Diagnosis* ; Dysarthria ; Female ; Fluorodeoxyglucose F18 ; Genes, vif ; Glucose ; Horns ; Humans ; Huntington Disease* ; Hyperkinesis ; Leukocytes ; Magnetic Resonance Imaging ; Metabolism ; Mild Cognitive Impairment ; Neurodegenerative Diseases ; Polymerase Chain Reaction* ; Positron-Emission Tomography ; Reference Values ; Siblings

OBJECTIVE: Angiogenesis is a critical factor in the progression of solid tumors. The mechanisms responsible for angiogenesis in cervical neoplasia, however, are not well defined. Our study was aimed to determine the expression of VEGF(Vascular Endothelial Growth Factor), its receptor(KDR), and TGF-beta1(Transforming Growth Factor-beta1) in cervical neoplasia, to determine the role of these angiogenic factors in preinvasive(dysplastic) process and the progression of cervical cancer and to investigate the progression of angiogenesis in the transition from normal cervix to invasive squamous cell carcinoma of the uterine cervix. METHODS: The cervical lesions of 76 patients were punch biopsied and paraffin embedded. Among these, 5 were normal cervix, 36 were cervical intraepithelial lesion I-III, and the other 35 were invasive squamous cell carcinomas. The tissues were immunostained with antiVEGF, antiKDR, and antiTGF-beta1 polyclonal antibody. RESULTS: The expression of VEGF, KDR, and TGF-beta1 in CIN III was stronger than those of CIN I(p<0.01). Their expression were not significantly different among the each staged cervical cancers(p>0.01). CONCLUSIONS: These observations suggest that VEGF, KDR, and TGF-beta1 are important angiogenic factors in cervical neoplasia, especially in an early event to neoplastic transformation of cervical tissues, but these angiogenic factors are not associated with the progression of cervical cancer.
Angiogenesis Inducing Agents ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Paraffin ; Phosphotransferases* ; Transforming Growth Factor beta1 ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A*