No abstract available.
Humans

No abstract available.
Urodynamics*

A male child of 9 months with bilateral Wilms tumor was admitted to our hospital. His chief complaint was abdominal mass. Clinical examination and IVP, USG and CT-scan disclosed bilateral Wilms tumor. Right nephrectomy and left partial nephrectomy were performed. Anuria was experienced to 24 hours and so exploratory-laparotomy was done. Renal autotranplantation was performed because of the thrombosis of renal artery. But six days after operation he died.
Anuria ; Child ; Humans ; Male ; Nephrectomy ; Renal Artery ; Thrombosis ; Wilms Tumor*

OBJECTIVES: Phenylpropanolamine (PPA) had been used widely as cold remedies or appetite suppressants. However, products containing PPA were withdrawn in sequence in the US, Japan, and Korea due to the increased risk of hemorrhagic stroke. The purpose of this paper was to review safety issues related with the PPA use and hemorrhagic stroke in view of pharmacoepidemiology and pharmacovigilance. METHODS AND MATERIALS: Researches conducted for evaluating the association between the PPA use and hemorrhagic stroke in other countries were reviewed, which involved case reports, case series, case-control studies, and cohort studies. RESULTS: In terms of pharmacologic and clinical features, PPA may increase the risk of hemorrhagic stroke through increased blood pressure, heart rate, or vasculitis. The association between the PPA use and hemorrhagic stroke among young women was suggested by case reports from spontaneous adverse events reporting systems or medical journals. The cohort study, using the large prescription database in the US and published in 1984, failed to reveal the association in the population aged below 65. The case-control study conducted as the Yale Hemorrhagic Stroke Project, published in 2000, was the first study to find the association between the PPA as appetite suppressants and hemorrhagic stroke among women ages 18-49 years by well-designed analytic epidemiological research. It led to withdrawal of all products containing PPA in the US and many other countries since 2000. However, the association between PPA and cerebral hemorrhage could not be confirmed by the case-control study conducted in Mexico due to inappropriate recruitment of control group. CONCLUSIONS: During several years case reports have suggested that hemorrhagic stroke could be induced by PPA, and the Yale Hemorrhagic Stroke Project revealed the association by case-control study and provided a useful model for pharmacovigilance. Nevertheless, their finding could not be applied to other population such as elderly women and male population. And they could not provide any evidence on the association between PPA and stroke when PPA was used as cold remedy taken daily dose below 100mg.
Aged ; Appetite Depressants ; Blood Pressure ; Case-Control Studies ; Cerebral Hemorrhage ; Cohort Studies ; Female ; Heart Rate ; Humans ; Japan ; Korea ; Male ; Mexico ; Pharmacoepidemiology ; Pharmacovigilance ; Phenylpropanolamine* ; Prescriptions ; Stroke* ; Vasculitis

Neurological manifestations of systemic lupus erythematosus (SLE) can mimic multiple sclerosis (MS) or Devic's syndrome (DS). We report a 16-year-old woman with recurrent myelitis and optic neuritis. She also had an antinuclear antibody, an anti double-stranded DNA antibody and a positive lupus erythematosus cell. Because MS is a diagnosis of exclusion, brainstem involvement is not compatible with DS. We therefore diagnosed her case as a SLE with recurrent myelitis and optic neuritis.
Adolescent ; Antibodies, Antinuclear ; Brain Stem ; Diagnosis ; DNA ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Multiple Sclerosis ; Myelitis* ; Neurologic Manifestations ; Neuromyelitis Optica ; Optic Neuritis*

BACKGROUND: Neurological syndromes often complicate the management of infective endocarditis. METHODS: We reviewed the neurological complications in 100 patients with infective endocarditis in a tertiary care hospital. RESULTS: Neurological complications occurred in 25 patients (25%). Ischemic infarctions occurred in 15 patients, hemorrhagic infarctions in 5, intracerebral hemorrhages in 12, subarachnoid hemorrhages in 4, and subdural hemorrhages in 2. Brain abscess was detected in 4 and seizures in 2 patients. Staphylococcus aureus endocarditis (p=0.01) and mitral valvular heart disease (p=0.015) correlated statistically with the development of neurological complications. The mortality rate was significantly higher in patients with neurological complications than those without neurological complications (p=0.00). Age, sex, and type of valve (native versus prosthetic) were not related to the complication rate. CONCLUSIONS: We concluded that (1) hemorrhagic complications occurred at a higher rate in this study than previous reports; (2) S.aureus infection and mitral valvular disease predicted the occurrence of neurological complications; and (3) neurological complications were related to mortality rates. (J Korean Neurol Assoc 19(3):202~206, 2001)
Brain Abscess ; Cerebral Hemorrhage ; Endocarditis ; Heart Diseases ; Heart Valve Diseases ; Hematoma, Subdural ; Humans ; Infarction ; Mortality ; Seizures ; Staphylococcus aureus ; Subarachnoid Hemorrhage ; Tertiary Healthcare

Duret hemorrhage is characterized by an upper brainstem hemorrhage due to increased intracranial pressure by mass effect such as subdural hematoma or a brain tumor. The anteroposterior elongation and downward displacement of the upper brainstem by transtentorial herniation results in the compression and tearing of the paramedian perforating vessels that feed the upper brainstem tegmentum. The consequent hemorrhage that involves the upper brainstem renders recovery to be almost impossible. Following a tricuspid valve replacement surgery, a 56-year-old woman developed a left fronto-temporo-parietal nontraumatic subdural hematoma resulting in transtentorial herniation of the left mesial temporal lobe. A successful surgical evacuation of the hematoma was done with clinical improvement. Two days later, she was referred to neurology with an aggravated right side weakness, dysarthria, and a newly developed extraocular movement disturbance. A brain CT and MRI showed a pontine hemorrhage. We report a case of pontine hemorrhage, a Duret hemorrhage, after the surgical evacuation of nontraumatic subdural hematoma.
Brain ; Brain Neoplasms ; Brain Stem ; Dysarthria ; Female ; Hematoma ; Hematoma, Subdural* ; Hemorrhage* ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Middle Aged ; Neurology ; Temporal Lobe ; Tricuspid Valve

Stroke ranks as one of the leading causes of death and the most common cause of permanent disability in adults in Korea. Timely recognition and treatment is imperative to reduce stroke-related morbidity and mortality. Patients with acute ischemic stroke should be evaluated for intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA); antiplatelet drugs can be administered to those who do not qualify for rt-PA therapy. Adequate hydration and correction of possible hypoxia are necessary, and hyperglycemia and fever should be treated aggressively. Blood pressure management should be individualized on the basis of stroke pathophysiology. It is important to prevent and manage complications of acute stroke, such as pneumonia, urinary tract infection, bed sore, deep vein thrombosis, and joint contracture. Meticulous evaluation of etiology of ischemic stroke can determine the most appropriate acute management and would guide the secondary prevention of stroke.
Adult ; Anoxia ; Blood Pressure ; Cause of Death ; Contracture ; Fever ; Humans ; Hyperglycemia ; Joints ; Korea ; Mortality ; Platelet Aggregation Inhibitors ; Pneumonia ; Pressure Ulcer ; Secondary Prevention ; Stroke* ; Urinary Tract Infections ; Venous Thrombosis

The mechanisms involved in brain neuronal damage in ischemia are related to the elevation of cytosolic calcium concentration and calcium antagonist is considered as a promising drug that may alleviate ischemic neuronal damage. Using transient global ischemia model of Mongolian gerbil, we studied the effect of nimodipine, a cerebroselective calcium antagonist, on ischemic brain edema. We treated each gerbil intraperitoneally with nimodipine (lmg/kg) or the same amount of saline 30 minutes prior to ischemia, and transient global ischemia was induced by means of clipping both common carotid arteries either for 10 minutes or for 45 minutes. Three hours after reperfusion, the animals were decapitated and the water content of the bain was determined by oven dry method. With 10 minute ischemia the brain water content in nimodipine pretreatment group (78.6 +/- 0.2%) was lower than that in saline pretreatment group (79.1 +/- 0.4%) significantly (p<0.05). But with 45 minute ischemia nimodipine pretreatment did not reduce the postischemic increase of water content compared with saline pretreatment (79.8 +/- 0.4% and 79 6 +/- 0.4%, respectively; not significant). Our results suggest that nimodipine pretreatment may suppress the development of ischemic brain edema and its effect depends largely on the extent of brain ischemia.
Animals ; Brain Edema* ; Brain Ischemia ; Brain* ; Calcium ; Carotid Artery, Common ; Cytosol ; Gerbillinae* ; Ischemia ; Neurons ; Nimodipine* ; Reperfusion

PURPOSE: To report three cases of rituximab treatment in refractory orbital inflammatory disease. CASE SUMMARY: Rituximab treatment was performed in three patients (thyroid-associated ophthalmopathy, orbital myositis, and idiopathic sclerosing inflammation) unresponsive to corticosteroid and radiotherapy. One cycle consisted of intravenous infusion of 1000 mg of rituximab, twice at a two-week interval. The patient with thyroid-associated ophthalmopathy exhibited clinical improvement in visual acuity, color vision, visual evoked potential, and visual field after one cycle of rituximab treatment. The patient with orbital myositis improved showed diplopia with a decrease in the size of the extraocular muscle after two cycles of treatment. The patient with idiopathic sclerosing inflammation showed improvements in visual acuity and visual field defect after one cycle of therapy. There were no severe infections or hematologic adverse effects including neutropenia, or decreased immunoglobulin during the follow-up period. CONCLUSIONS: Treatment with rituximab appears to offer another therapeutic option in patients unresponsive to corticosteroid or radiotherapy.
Antibodies, Monoclonal, Murine-Derived ; Color Vision ; Diplopia ; Evoked Potentials, Visual ; Follow-Up Studies ; Graves Ophthalmopathy ; Humans ; Immunoglobulins ; Inflammation ; Infusions, Intravenous ; Muscles ; Neutropenia ; Orbit ; Orbital Myositis ; Visual Acuity ; Visual Fields ; Rituximab