Holmes' tremor is a condition characterized by a mixture of postural, rest, and action tremors due to midbrain lesions in the vicinity of the red nucleus. Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubro-olivary pathway and may present clinically as Holmes tremor. We report on a 59-year-old female patient who developed Holmes tremor in association with bilateral HOD, following brain stem hemorrhage.
Brain Stem* ; Female ; Hemorrhage* ; Humans ; Mesencephalon ; Middle Aged ; Neurons ; Olivary Nucleus ; Red Nucleus ; Tremor*

We report a case of methicillin-resistant Staphylococcus aureus (MRSA) endocarditis involving tricuspid valve in small ventricular septal defect with multiple pulmonary embolism. A 36-years-old woman presented with 7 days course of fever and mental abnormality. She had small-sized ventricular septal defect (VSD) and no risk factors for the infection such as history of intravenous drug abuse and hospitalization. Methicillin- resistant Staphylococcus aureus was isolated from all three sets of blood culture drawn on admission and from the huge pulmonary embolus retrieved during operation. Resection of pulmonary emboli and patch repair of ventricular septal defect were done. Teicoplanin was administered for a total of 28 days due to febrile rash associated with vancomycin treatment after operation. She was discharged without complication.
Embolism ; Endocarditis* ; Exanthema ; Female ; Fever ; Heart Septal Defects, Ventricular* ; Hospitalization ; Humans ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Pulmonary Embolism* ; Risk Factors ; Staphylococcus aureus ; Substance Abuse, Intravenous ; Teicoplanin ; Tricuspid Valve* ; Vancomycin

Technical advances in computer image analysis have made possible three-dimensional(3D) surface Informations of anatomic structures from contiguous axial CT slices. We have recently utilized this 3D CT reconstruction with spiral CT scanner in 6 consecutive patients with primary or secondary craniosynostosis to assess the presence and extent of synostosis, associated calvarial deformity and to facilitate surgical planning of the craniectomy site. High resolution 3-mm contiguous CT sections were obtained and 3D shaded-surface reconstruction image generated after reformation at 2-mm interval. In each case 3D CT demonstrated the exact extent of synostosis, and in 3 cases it was confirmed by surgical inspection. 3D CT images facilitated surgical planning by precisely localizing the proper site for craniectomy. Three-dimensional CT with shaded-surface display may be a useful adjunct to imaging and surgical planning in the patients with craniosynostosis, as well as a useful follow-up imaging study during observation or after surgery.
Congenital Abnormalities ; Craniosynostoses* ; Follow-Up Studies ; Humans ; Synostosis ; Tomography, Spiral Computed

In the previous studies, we found that lumbrokinase an, extract from Korean earthworm, had a strong in vitro thrombolytic effect, and that when added to thrombin had a significant effect in reducing fatality rate in thrombin-induced lung infarction mice model. To determine whether it also has in vivo thrombolytic effect in cerebral embolism model using 9 Spraw Dawly male rats of 200 to 300gm, we cannulated the extemal carotid artery lene tubes and occluded the pterygopalatine arteries. Via the extemal carotid artery, we injected 1 mm3 of human blood clots which were previously mixed with Tc-99m sulfur colloid. After confirming the intracranially situated clot by camera, we injected 3cc of following fiuids to each group of three rats: saline, urokinase, lumbrokinase fraction m Then using Gamma camera of 64*64 m obtained for 1 minute in every 30 minutes. After 150 minutes radioactivities of the clots in the brain were 3.02%, 21 02% urokinase, and lumbrokinase treated animals respectively. In the liver, the uptake of radioactivities was accordingly increased. Brain sections showed no Significant intracranial bleeding in any of the treated animals. Therefore, we conclude that lumbrokinase has in vivo thromboembolism model without producing significant intracranial bleeding. However, compared with its in vitro effects the in vivo effects appear to be less potent. Futher experiments with better designed animal models are warranted.
Animals ; Arteries ; Brain ; Carotid Arteries ; Gamma Cameras ; Hemorrhage ; Humans ; Infarction ; Intracranial Embolism ; Liver ; Lung ; Male ; Mice ; Models, Animal ; Oligochaeta ; Radioactivity ; Rats* ; Technetium Tc 99m Sulfur Colloid ; Thrombin ; Thromboembolism* ; Urokinase-Type Plasminogen Activator

Malacoplakia is an uncommon granulomatous inflammatory disease, which predomina- ntly affected the urinary tract, particularly the urinary bladder. The prostatic involve- ment of malacoplakia is extremely rare and may clinically mimic prostate cancer. A correct diagnosis of malacoplakia can be made by histopathologic findings characterized by accumulations of macrophages containing typical intracytoplasmic inclusions(Michael is-Gutmann bodies). We report a case of prostatic malacoplakia, which was incidentally found in prostate biopsy performed to confirm clinically suspected prostate cancer.
Biopsy ; Diagnosis ; Macrophages ; Malacoplakia* ; Prostate* ; Prostatic Neoplasms ; Urinary Bladder ; Urinary Tract

OBJECTIVE: We evaluated the relationship between transcranial Doppler sonography (TCD) and three-dimensional computerized tomography angiography (3D-CTA) under delayed ischemic neurologic deficit (DIND) with angioplasty following vasospasm. MATERIALS & METHODS: Twenty consecutive patients with DIND following vasospasm who received sequential TCD and CTA were analyzed. On TCD, vasospasm was defined as anterior circulation peak mean velocity>120 cm/s, daily increases of 50cm/s, and a Lindegaard ratio (LR)degrees root 3. On 3D-CTA data were subdivided into local and combined types according to the position where vasospasm occurred, and into mild, moderate, and severe by the blood vessel diameter. RESULTS: Among the 20 consecutive patients with DIND, 13 of them received angioplasty. On TCD, the angioplasty group had more frequent vasospasm and tended to have an LR higher than 3. The mean blood flow velocity of MCA in the angioplasty group was 40 cm/sec higher than the group without angioplasty. On CTA, the angioplasty group showed combined, moderate types more frequently. After 3D-CTA evaluation, TCD sensitivity, specificity, positive predictive value and negative predictive value, analyzed with the index of diminished vessel diameter that was more than moderate, were 92.6%, 83.3%, 72.2% and 50.0%, respectively. CONCLUSION: TCD and 3D-CTA could be useful tools for evaluation and management planning of critical patients suspected of having DIND by vasospasm.
Angiography ; Angioplasty ; Blood Flow Velocity ; Blood Vessels ; Glycosaminoglycans ; Humans ; Neurologic Manifestations ; Sensitivity and Specificity ; Subarachnoid Hemorrhage ; Ultrasonography, Doppler, Transcranial

OBJECTIVE: Our purpose was to evaluate the effect of transabdominal cervicoisthmic cerclage before pregnancy among the patients who had poor obstetric outcome from previous failed transvaginal cervical cerclage and/or an anatomically defective cervix. STUDY DESIGN: A retrospective review of pre-conceptional transabdominal cervicoisthmic cerclage patients was conducted at Hanyang University Medical Center from 1989 to 1997, and analysis of the pregnancy outcomes after preconceptional transabdominal cervicoisthmic cerclage operation. RESULTS: The fifteen patients had 11 successful pregnancy outcomes. Two patients had two consecutive succesful pregnancies and repeat cesarean section deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage before pregnancy offers a high rate of fetal salvage with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.
Academic Medical Centers ; Cerclage, Cervical ; Cervix Uteri ; Cesarean Section, Repeat ; Female ; Humans ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Retrospective Studies ; Uterine Cervical Incompetence

BACKGROUND: As aging occurs, the skin develops more wrinkles and pigmentation, becomes drier, and loses its elasticity. In previous reports, light-emitting diode (LED) phototherapy was proven to stimulate collagen synthesis and accelerate fibroblast-myofibroblast transformation, which has a composite rejuvenation effect. OBJECTIVE: To evaluate the effectiveness and safety of LED phototherapy with 592 nm yellow light for photoaged skin. METHODS: Forty patients with photoaged skin (Korean photographic scale; grade 4approximately7) were enrolled and treated with an LED device producing 592+/-10 nm yellow light for 5 minutes twice a week for 4 weeks. The skin changes were assessed at 0, 2, 4, and 8 weeks by clinical photographs and the Cutometer(R) & Mexameter(R) (MPA 580, Courage+Khazaka Electronic GmbH, Koln, Germany). Measurements were made on the cheek, periorbital area, nasolabial fold, and glabella. RESULTS: At the final visit at 8 weeks, the Cutometer(R) parameters R4 and R6 decreased significantly compared to before treatment, from 0.118 to 0.099 for the periorbital (p=0.017) and 0.517 to 0.425 for the nasolabial fold (p=0.003). The average melanin index decreased significantly, from 133.65 to 124.55 (p<0.005). Fine improvement of wrinkles was shown grossly by reviewing follow-up clinical photographs. No adverse reactions occurred. LED phototherapy with 592+/-10 nm wavelength can be effective and safe in the treatment of photoaged skin. CONCLUSION: The findings suggest the LED with 592 nm yellow light might be an adjuvant therapeutic tool for photoaged skin.
Aging ; Cheek ; Collagen ; Elasticity ; Follow-Up Studies ; Humans ; Melanins ; Nasolabial Fold ; Phototherapy ; Pigmentation ; Rejuvenation ; Skin*

BACKGROUND AND OBJECTIVES: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS: A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS: Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
Cohort Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death ; Follow-Up Studies ; Homocysteine* ; Humans ; Male ; Myocardial Infarction ; Prognosis ; Propensity Score* ; Risk Factors

OBJECTIVES: In coronary arterial disease, quantitative assessment of the extent of myocardial damage is important both in management of the patient and prediction of prognosis. Measurement of serum Troponin-T is a new method for detecting myocardial cellular injury, used as more specific marker of tissue damage and reperfusion status in acute myocardial infarction, This study was performed to evaluate the significance of serum Troponin-T measurement in various acute chest pain syndrome. METHODS: 37 patients who presented anterior ischemic chest pain enrolled from April, 1994 to September, 1995, From the initial period of admission, serial measurements of serum level of cardiac enzymes (CK, CK MB, Myoglobin, Troponin-T) were made. Then release time, peak time and normalization time of each enzyme were derived and compared each other. To evaluate whether Troponin-T level can reflect the extent of ischemic injury, correlation between peak Troponin-T level and peak CK MB level was analysed by regression method. RESULTS: 1) Acute myocardial infarction was confirmed in 15 cases; Q-wave myocardial infarction was 10 cases(anterior wall-5 cases, inferior wall-4 cases, lateral wall-1 cases), and non Q-wave myocardial infarction was 5 cases. Unstable angina was 22 cases. All cases had significant stenosis in coronary angiography. 2) The appearance in the serum level of 4 cardiac enzymes was as follows. The release time(hours) of 4 cardiac enzymes(Troponin-T, CK, CK MB, Myoglobin) were 7.1(1-30), 9.3(1-30), 9.9(1-30), 6.2(1-30). The peak time(hours) of 4 cardiac enzymes were 23.0(1.5-96), 21.6(2-66), 16.9(2-42), 12.7(3-40). The normalization time(hours) of the enzymes were over 72, 53.7(11-86), 52.3(11-94), 32.3(10-82). 3) Elevation pattern of cardiac enzymes showed concordance of all 3 enzymes(Troponin-T, CK MB, Myoglobin) in 29 of 43 cases(67.4%), There was concordance of 2 enzymes in 10 cases; 5 cases of CK MB and Myoglobin, 5 cases of Troponin-T and Myoglobin. In 4 cases, only Myoglobin level was increased. 4) There was significant correlation between peak Troponin-T level and peak CK level(r=0.66, p=0.0178), significant correlation was also observed between peak Troponin-T level and peak CK MR level(r=0.90, p=0.0001). CONCLUSION: In acute myocardial infarction serum Troponin-T was detectable as early as CK MB, and lasted longer after other enzyme level was normalized. There was significant correlation between peak Troponin-T level and peak CK, CK MB level, suggesting Troponin-T as useful marker for assessing the extent of myocardial damage.
Angina, Unstable ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Humans ; Myocardial Infarction ; Myoglobin ; Prognosis ; Reperfusion ; Troponin T*