This study was undertaken to evaluate the clinical usefulness of magnetic evoked potentials(MEP) in localization of motor pathway lesions and the relation between motor weakness and MEP alterations. The patient group consisted of 50 patients(33 men and 17 women) with vanous diseases involving motor pathway, among which were 21 cerebral infarction, 15 intracerebrai hemorrhage, 3 cervical spondylosis, 3 amyotrophic lateral sclerosis and 8 peripheral polyneuropathy, confirmed by neurological findings, CT or MRI, EMG and nerve conduction velocity. The results were compared with 20 healthy subjects (11 men and 9 women) as a control group. MEP were recorded by using Digitimer magnetic stimulator model Dl90 and Medelec ER 94a/Sensor apparatuses, and MEP were evoked by magnetic stimulations over the vertex, the 7th cervical vertebra and Erb's point, and central motor conduction time (CMCT) was calculated by substracting the onset latency of abductor pollicis brevis muscle responses obtained by stimulation over the C7 vertebra from that obtained by stimulation over the scalp. The mean latencies of MEP after transcranial magnetic stimulations were prolonged in patients with motor pathway lesion, and mean CMCT were prolonged in patients with stroke. Cortical MEP were not elicited in stroke patients with profound motor weakn-ess below motor power 2/5 in arm, Prolongation of mean latency of cortical MEP and mean CMCT were correlated with motor weakness below motor power 4/5. In stroke patients, there were prolongation of mean CMCT and mean latency of cortical MEP evoked by stimulation to the undamaged hemisphere. These results suggest that magnetic MEP test is safe and useful in evaluation of motor pathway lesions.
Amyotrophic Lateral Sclerosis ; Arm ; Cerebral Infarction ; Evoked Potentials, Motor* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Neural Conduction ; Polyneuropathies ; Scalp ; Spine ; Spondylosis ; Stroke ; Transcranial Magnetic Stimulation

BACKGROUND: Scabies outbreaks have been reported in long-term care facilities, but less commonly in acute care facilities. We experienced an outbreak of scabies that occurred in neurosurgery-intensive care unit of a general hospital, Seoul, Korea. METHODS: An outbreak of scabies was noticed on September 2006 when hospital staffs of NICU were diagnosed with scabies. The infection control nurse reviewed medical records and interviewed all of patient in NICU and health care workers. The epidemic spread of scabies from a patient to other patient, hospital employees and their families and associates was identified from historical, clinical, and microbiologic skin preparation data. RESULTS: Forty-three NICU patients and 22 health care workers were investigated. Five scabies cases were identified in total of 42 cases who are exposed to index case with attack rate of 11.9%. The attack rate of scabies in health care workers and NICU patients were 10% and 13.6%, respectively. Tertiary cases also occurred among the family members of workers, with a tertiary attack rate of 44%. CONCLUSION: The patient of acute care facilities also have chances of being exposed to scabies outbreak, since sensorimotor deficits or cognitive disorders make it difficult for individuals to communicate and understand the implication of risky contacts.
Delivery of Health Care ; Disease Outbreaks ; Hospitals, General ; Humans ; Infection Control ; Long-Term Care ; Medical Records ; Scabies ; Skin

Chemotherapeutic agents were evaluated for their effect on the development of urinary bladder tumors, induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in female Sprague-Dawley rats. For 16 weeks, 0.05% BBN was administered orally, and then chemotherapeutic agents (adriamycin and cisplatin) were injected intraperitoneally for 12 weeks. In our preliminary experimental series, an experimental bladder tumor model induced by BBN was useful in evaluating the effectiveness of chemotherapeutic agents. Cisplatin appears to be effective in inhibiting precancerous histologic changes and carcinoma in rat urinary bladder mucosa by BBN. However, the effectiveness of adriamycin was inconclusive.
Animals ; Carcinogenesis* ; Cisplatin ; Doxorubicin ; Female ; Humans ; Injections, Intraperitoneal* ; Mucous Membrane ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder Neoplasms ; Urinary Bladder*

BACKGROUND: During a 1-month period in 2005 , a series of 4 Leclercia adecarboxylata and 8 Pseudomonas aeruginosa bacteremias were reported from patients admitted to the emergency room. METHODS: An outbreak of L. adecarboxylata and P. aeruginosa bacteremia that occurred from February to March 2005 was investigated. The infection control nurse reviewed medical records and observed the procedures of blood cultures at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from alcohol sponge, tray, sink, water of sink, saline cotton, microscope, computer, and telephone. RESULTS: L. adecarboxylata was isolated from 4 patients and P. aeruginosa from 8 patients during a 1-month period. Observation of the culture procedure revealed that saline cotton was used to prevent betadin skin discoloration. The culture of the saline solution yielded a heavy growth of P. aeruginosa, which was not isolated from any other specimens. CONCLUSIONS: This was a pseudoepidemic caused by contaminated saline cotton. The use of the saline cotton was stopped, and during the follow-up period of 3 months, no additional L. adecarboxylata or P. aeruginosa bacteremia were reported.
Bacteremia ; Emergency Service, Hospital ; Enterobacteriaceae* ; Follow-Up Studies ; Humans ; Infection Control ; Medical Records ; Porifera ; Pseudomonas aeruginosa ; Skin ; Sodium Chloride ; Telephone ; Water

The clinical triad of relapsing iritis, ulcers of the mouth and genitalia was first described in 1939 by Hulusi Behcet. This entity, originally confined to the above triad of symptoms appears to be systemic disease manifested by skin lesion, thrombophlebitis, neurologic, cardiovascular or visceral symptoms. The vascular involvement in Behcet's syndrome has been reported since Mischima first described a case in 1961, four types of vascular lesion are freuqnetly observed most commonly on the inferior or superior vena cava. Treatments consist of anticoagulation and administering oral steroids. We report a case of SVC obstruction in 36 years old female patient with Behcet's syndrome.
Adult ; Behcet Syndrome* ; Female ; Genitalia ; Humans ; Iritis ; Mouth ; Skin ; Steroids ; Thrombophlebitis ; Ulcer ; Vena Cava, Superior

Blood culture is important to detecting bacteremia and fungemia in patients with suspected sepsis. We observed a four-year trend of blood culture isolates in the frequency by age group and in vitro antimicrobial susceptibility patterns obtained at VHS Medical Center, the largest veterans hospital in Korea. Blood cultures collected between 2012 and 2015 were analysed retrospectively. Of 68,352 blood specimens, 7,901 isolates were identified during the study period. Seventy-two percent of the isolates were gram-positive cocci, 18% were gram-negative rods, and 6% were fungi. The frequency of bacteremia/fungemia in patients who were 80–89 years old was 43.8%, the highest rate among all age groups, and the mean age of patients diagnosed by blood culture was 77 years old. Coagulase-negative staphylococcus (52.3%), Staphylococcus aureus (8.3%), enterococci (7.5%), Escherichia coli (6.4%), and Klebsiella pneumoniae (3.9%) were the bacteria most commonly isolated. The percentage of methicillin-resistant S . aureus increased in 2015 (76%) relative to that in 2012–2014 (63%–65%), and that of vancomycin-resistant Enterococcus faecium was 17%–22% with no significant changes through time. Among the gram-negative isolates, the ciprofloxacin resistance rate increased to 51.4% (E. coli ) and 31.1% (K. pneumoniae ) in 2015, but imipenem or ertapenem resistance was still very rare, with resistance rates of less than 0.5%. Acinetobacter baumannii showed a high rate of resistance (over 70%) to imipenem and ciprofloxacin throughout the study. In Pseudomonas aeruginosa , the resistance rates of imipenem and ciprofloxacin increased dramatically over time. This analysis confirmed a decrease in antimicrobial susceptibility of gram-negative rods isolated by blood culture.
Acinetobacter baumannii ; Bacteremia ; Bacteria ; Ciprofloxacin ; Enterococcus faecium ; Escherichia coli ; Fungemia ; Fungi ; Gram-Positive Cocci ; Hospitals, Veterans* ; Humans ; Imipenem ; In Vitro Techniques ; Klebsiella pneumoniae ; Korea ; Methicillin Resistance ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Sepsis ; Staphylococcus ; Staphylococcus aureus ; Veterans*

Six hundred and fifty one cases of bone tumors diagnosed and operated at Department of Orthopedic Surgery, Seoul National University Hospital, from Jan., 1969 to Apr., 1989. were reviewed and analyzed with respect to the types of tumor, the age and sex distribution of the patients, the location of the lesions and the advances of diagnosis and treatment. 378 benign and 273 malignant bone tumors were identified. Osteochondroma(113 cases, 17.4%) was the most common bone tumor, followed by osteosarcoma(72 cases, 11.1%) and giant cell tumor(50 cases, 7.7%) Second decade was the most common age of bone tumors(216 cases, 33.2%) and male(379 cases, 58%) was more common than female. Femur(222 cases) was the most common site of bone tumors, followed by tibia and vertebra. For simple bone cyst, steroid injection was widely used recently. It was a simple and safe procedure and its results were similar to those of curettage and bone graft. Limb salvage operations were performed for malignant bone tumors increasingly. Neoadjuvant chemotyeraphy and limb salvsge operation using tumor prosthesis were performed in 5 patients of osteosarcoma and their results are so far promising. Of 7 cases of chondrosarcoma, the limb was salvaged by resection arthrodesis or resection arthroplasty. 7 cases of malignant fibrous histiocytoma were treated by radical ablative surgery and/or chemotherapy and radiation, but local recurrence or pulmonary metastasis were detected in all of them. So it was thought to be highly malignant bone tumors.
Arthrodesis ; Arthroplasty ; Bone Cysts ; Chondrosarcoma ; Curettage ; Diagnosis ; Drug Therapy ; Epidemiologic Studies ; Extremities ; Female ; Giant Cells ; Histiocytoma, Malignant Fibrous ; Humans ; Limb Salvage ; Neoplasm Metastasis ; Orthopedics ; Osteosarcoma ; Prostheses and Implants ; Recurrence ; Seoul ; Sex Distribution ; Spine ; Tibia ; Transplants

BACKGROUND: Lambert-Eton myasthenic syndrome(LEMS) is characterized by the clinical triad of muscle weakness, hyporeflexia, and autonomic dysfunction. In contrast to myasthenia gravis.LEMS is not commonly associated with respiratory failure. Any case of respiratory failure in LEMS has not been reported in Korea. CASE DESCRIPTION: The first case is a 61-tear-old male complained of proximal muscle weakness and dysarthria associated with severe dry mouth for 3 month and developed respiratory failure. The second case is a 65-tear-old male who began complaining of muscle weakness, weight loss, dry mouth, and recurrent respiratory difficulty for 14 months. Repetitive nerve stimulation(RNS) test for ulnar nerve showed CMAP with low amplitude, a significant decremental response at the low rate stimulation and a marked incremental response at the high rate stimulation in the left abductor digiti muscles in both cases. The first case had small cell carcinoma of the lung, but the second case presented with respiratory failure in the absence of malignancy. CONCLUSION:We experienced two cases of LEMS presenting respiratory failure. To our knowledge, this is the first report of respiratory failure in LEMS in Korea.
Carcinoma, Small Cell ; Dysarthria ; Humans ; Korea ; Lambert-Eaton Myasthenic Syndrome* ; Lung ; Male ; Mouth ; Muscle Weakness ; Muscles ; Reflex, Abnormal ; Respiratory Insufficiency* ; Ulnar Nerve ; Weight Loss

BACKGROUND: Lambert-Eton myasthenic syndrome(LEMS) is characterized by the clinical triad of muscle weakness, hyporeflexia, and autonomic dysfunction. In contrast to myasthenia gravis.LEMS is not commonly associated with respiratory failure. Any case of respiratory failure in LEMS has not been reported in Korea. CASE DESCRIPTION: The first case is a 61-tear-old male complained of proximal muscle weakness and dysarthria associated with severe dry mouth for 3 month and developed respiratory failure. The second case is a 65-tear-old male who began complaining of muscle weakness, weight loss, dry mouth, and recurrent respiratory difficulty for 14 months. Repetitive nerve stimulation(RNS) test for ulnar nerve showed CMAP with low amplitude, a significant decremental response at the low rate stimulation and a marked incremental response at the high rate stimulation in the left abductor digiti muscles in both cases. The first case had small cell carcinoma of the lung, but the second case presented with respiratory failure in the absence of malignancy. CONCLUSION:We experienced two cases of LEMS presenting respiratory failure. To our knowledge, this is the first report of respiratory failure in LEMS in Korea.
Carcinoma, Small Cell ; Dysarthria ; Humans ; Korea ; Lambert-Eaton Myasthenic Syndrome* ; Lung ; Male ; Mouth ; Muscle Weakness ; Muscles ; Reflex, Abnormal ; Respiratory Insufficiency* ; Ulnar Nerve ; Weight Loss

Adult onset Still's disease (AOSD) is a systemic autoinflammatory disorder that presents with recurrent fever, extreme fatigue, and joint pain. Pulmonary involvement is not uncommon and, although rare, severe pneumonitis can progress to respiratory failure. Still's disease-associated pneumonitis is generally treated with immunosuppressive agents, but improvement in our understanding of systemic inflammatory processes led us to explore alternative agents. Anakinra is an interleukin-1 receptor antagonist used to treat autoinflammatory disorders resistant to immunosuppressive therapy. Several case reports have demonstrated efficacy of anakinra in treating AOSD, but its relevance in cases complicated with severe pneumonitis has not been examined. Our patient's disease activity was not controlled with systemic steroids and cyclophosphamide. Treatment with anakinra led to a dramatic clinical response. This is the first reported case of AOSD with severe pneumonitis refractory to conventional therapy successfully treated with anakinra.
Arthralgia ; Cyclophosphamide ; Fatigue ; Fever ; Immunosuppressive Agents ; Interleukin 1 Receptor Antagonist Protein* ; Interleukin-1 ; Pneumonia* ; Respiratory Insufficiency ; Steroids ; Still's Disease, Adult-Onset*