A 14-year old boy presented with myoclonic seizure with rightward deviation of eyeballs. Three years ago, he was diagnosed as diabetes necessitating insulin injection. At that time, his blood glucose was 448mg/dl, HbA1c 27.8%, serum C-peptide rose from 0.4 to 1.1ng/ml after glucagon, and 24 hour urine C-peptide was 6.7microg/day. Eye examination was normal. His maternal grandmother died of diabetes at 50 years old, and his mother's sister and his elder sister had NIDDM with oral hypoglycemics. But, he didn't control hyperglycemia himself since that time. On physical exam, his grasping power was decreased in right hand, and cataract was detected at the posterior pole of lenses in both eyes requiring surgery. EEG showed partial seizure disorder in left frontoparietal area, and MRI revealed cerebral infarction in left frontoparietal cortex. Sensory-motor polyneuropathy was noted in nerve conduction velocity. His neurologic symptom was improved gradually with insulin therapy, but nerve conduction velocity and MRI abnormalities did not improved after 6 months of follow-up. Although long-term diabetic complication is common in poorly controlled diabetes, very early manifested eye and nervous system complications like this case is extremely uncommon.
Adolescent ; Blood Glucose ; C-Peptide ; Cataract ; Cerebral Infarction ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Electroencephalography ; Epilepsies, Partial ; Follow-Up Studies ; Glucagon ; Hand ; Hand Strength ; Humans ; Hyperglycemia ; Hypoglycemic Agents ; Insulin ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nervous System ; Neural Conduction ; Neurologic Manifestations ; Polyneuropathies ; Seizures ; Siblings

No abstract available.
Gastric Mucosa* ; Helicobacter pylori* ; Helicobacter*

OBJECTIVES: It has been known that the contents of dreams change according to neuro-developmental differences in sex, progression of age and various environments, unlike the established psychoanalytic theory. To investigate the changes, we collected "most recent dream report" and analyzed the contents of dreams by using Hall/Van de Castle System. METHOD: Most recent dream reports were gathered from age 12-14 years old, 2,673 middle school students (1,544 male 1,129 female) and analyzed those reports using Hall/Van de Castle System. The data were sorted in SAS and dream SAT. RESULT: There were prominent differences between male and female middle school students in Male/Female Percentage (male/female; 56%/35%), Familiarity Percentage (57%/69%), Aggression/Friendliness Percentage (79%/65%), Befriender Percentage (50%/33%), Physical Aggression Percentage (90%/70%), Indoor Setting Percentage (40%/55%), Negative Emotion Percentage (56%/68%) and Torso/Anatomy Percentage (51%/36%). There were significant differences in Male/Female Percentage (65%/44%), Friendliness, Physical Aggression and Self Negativity Percentage in male and there were significant differences in Friendliness, Familiarity and Friends Percent in female between 1st and 2nd grade. But, it showed much similar dream patterns between 2nd and 3rd grade in both gender. In male, Aggression/Character Index with male character is significantly increased by 2nd grade (1st/ 2nd/ 3rd; 0.48/1.04/0.98), In female, Friendliness/Character Index with male character had significantly decreased by 2nd grade (0.38/0.19/0.20). CONCLUSION: There were apparent differences between age 12-14 years old male and female. Male adolescents have differences mostly in categories related with aggression, but female adolescents have differences in categories related with environment or character. It shows that developmental level of male are slower than female as of yet and male needs more active interpersonal relationship to find identity. Otherwise, the influences of passive attitude and actual circumferential environment are reflected in female's dream. There are no prominent differences among ages, but age 12-13 years old adolescents shows significant differences in interacting with the other gender. It means that circumferential environment and interpersonal relationship affect the contents of dreams and also the cognitive development related to age and sex. Afterwards, the development of dreams could be better understood through the neurocognitive study and dream analysis between other ages and nations.
Adolescent* ; Aggression ; Dreams* ; Female ; Friends ; Humans ; Male ; Psychoanalytic Theory ; Recognition (Psychology)

The majority of ptients with ischemic heart disease such as angina pectoris and myocardial infarction have coronary atherosclerosis as a underlying cause. However, in unusual conditions such as variant angina, aortic valvular heart disease, hypertrophic cardiomyopathy, vasculitis, hypercoagulable states, coronary atherosclerosis is not the cause. Polycythemia vesa is a myeloproliferative disease characterized by infrequent thromboembolic complications such as ischemic heart disease. We report a case of polycythemia vera presenting with angina pectoris without coronary artery stenosis with the review of the literature.
Angina Pectoris* ; Cardiomyopathy, Hypertrophic ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Heart Valve Diseases ; Myocardial Infarction ; Myocardial Ischemia ; Polycythemia Vera* ; Polycythemia* ; Vasculitis

PURPOSE: Cyanotic congenital heart diseases patients are in a state of hypoxia since birth. In general, hypoxia delays atrioventricular conduction. The atrioventricular node in such a hypoxic condition would have a different function, and some possibility for arrhythmia. The authors studied atrioventricular nodal function during hypoxia to elucidate the relationship between hypoxia and arrhythmia, including atrioventricular node in terms of cardiac tissue level. METHODS: After extraction of an adult rabbit heart under pentobarbital anesthesia, the heart was retrogradely perfused through the aorta with graded hypoxic Krebs' solution(100, 70, and 50% oxygen). The intracardiac electrocardiograms were obtained by a custom-made programmed stimulation at basic cyde length 40ms antegradely and retrogradely. All the data was analysed at His-electrogram and conduction time. Refractory periods and Wenckebach cycling length were determined. RESULTS: During antegrade conduction, the fast AV nodal conduction was prolonged and the slow conduction shortened, resulting in decreased compliance of the AV nodal conduction with graded hypoxia. The His-Purkinje system also showed a similar result. Among the refractory periods, only the AV nodal effective refractory period was prolonged with hypoxia. Wenckebach cycle length was sensitive to hypoxia, especially for retrograde conduction. CONCLUSION: Because the AV conduction during hypoxia was characterized by decreased AV conduction compliance, prolonged AV nodal effective refractory period, and sensitive Wenckebach cyding length, hypoxia would not seem to be a special risk for arrhythmia, including AV node.
Adult ; Anesthesia ; Anoxia* ; Aorta ; Arrhythmias, Cardiac ; Atrioventricular Node ; Compliance ; Electrocardiography ; Heart Diseases ; Heart* ; Humans ; Parturition ; Pentobarbital

Previous studies reported that oxaliplatin is associated with sinusoidal obstruction syndrome. However few reports on oxaliplatin induced liver fibrosis are found in the literature. Furthermore pathogenesis of liver fibrosis is not well known. We report a case of 45-yr-old Korean man in whom liver fibrosis with splenomegaly developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for colon cancer (T4N2M0). Thorough history taking and serological examination revealed no evidence of chronic liver disease. Restaging CT scans demonstrated a good response to chemotherapy. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with necrosis without steatosis. We could conclude that splenomegaly was due to perisinusoidal liver fibrosis and liver cell necrosis induced portal hypertension by oxaliplatin. In addition, to investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and alpha-smooth muscle actin (alpha-SMA) were conducted with control group. The immunohistochemical stains for CD31 and alpha-SMA were positive along the sinusoidal space in the patient, while negative in the control group. Chemotherapy with oxaliplatin induces liver fibrosis which should be kept in mind as a serious complication.
Actins/metabolism ; Antigens, CD31/metabolism ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Camptothecin/*analogs & derivatives/therapeutic use ; Chemotherapy, Adjuvant ; Colonic Neoplasms/*drug therapy ; Fluorouracil/therapeutic use ; Humans ; Hypertension, Portal/etiology ; Immunohistochemistry ; Leucovorin/therapeutic use ; Liver Cirrhosis/*diagnosis/etiology/pathology ; Liver Neoplasms/secondary/surgery ; Male ; Middle Aged ; Organoplatinum Compounds/*administration & dosage/adverse effects/therapeutic use ; Splenomegaly/*diagnosis/etiology ; Thrombocytopenia/etiology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The current study examines the expression of molecular biomarkers in hepatocellular carcinoma (HCC) and whether these findings correlate with the clinicopathologic features of the disease and patient survival. METHODS: We analyzed the immunohistochemical expression of p53, mammalian target of rapamycin (mTOR), c-Met, and insulin-like growth factor 1 receptor (IGF-1R) heat shock protein 70 (HSP70) with the clinicopathologic features of 83 HCCs. RESULTS: p53 expression was higher in the male patients with undifferentiated histological tumor grades, cirrhosis, and portal vein invasion. High 48 c-Met expression correlated with cirrhosis, and high mTOR expression correlated with the tumor grade and cirrhosis. High IGF-1R expression correlated with the tumor grade and cirrhosis. A multivariate analysis identified a significant relationship between the high expression of p53, tumor grade, and portal vein invasion. In addition, a high expression of mTOR was related to tumor grade and cirrhosis, and a high expression of HSP70 was related to portal vein invasion in a multivariate analysis. The Kaplan-Meier survival curve for patients with high versus low Edmondson grades and p53 expression was statistically significant. CONCLUSIONS: p53, mTOR, and IGF-1R expression correlated with the Edmondson tumor grade in a univariate analysis, while p53 and mTOR correlated with the Edmondson tumor grade in a multivariate analysis. In addition, the tumor grade was found to predict survival. p53 was primarily related to the clinicopathologic features compared to other markers, and it is a poor prognostic factor of survival.
Adult ; Aged ; Carcinoma, Hepatocellular/*metabolism/surgery ; Disease-Free Survival ; Female ; HSP70 Heat-Shock Proteins/metabolism ; Humans ; Liver Neoplasms/*metabolism/surgery ; Male ; Middle Aged ; Prognosis ; Proto-Oncogene Proteins c-met/metabolism ; Receptor, IGF Type 1/metabolism ; Retrospective Studies ; Risk Factors ; TOR Serine-Threonine Kinases/metabolism ; Treatment Outcome ; Tumor Markers, Biological/*metabolism ; Tumor Suppressor Protein p53/metabolism

Amiodarone chlorhydrate is a diiodated benzofuran derivative, and it is used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone, and symptomatic hepatic dysfunction occurs in fewer than 1% of the patients taking amiodarone. Cirrhosis is a rare complication that's been confirmed in 12 cases. Peripheral neuropathy occurs in 10% of patients taking aminodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity and peripheral neurotoxicity. A 75 year old man with normal liver function was given amiodarone for treating his atrial fibrillation and heart failure. He developed nausea, vomiting, muscle weakness and wasting after 17.8 months therapy with amiodarone (400 mg orally once per day). Liver biopsy showed the presence of foam cells in the hepatic sinusoids and Mallory bodies in the periportal hepatocytes on light microscopy. Sural nerve biopsy showed demyelination, and nerve conduction studies showed mixed sensorimotor polyneuropathy. These observations show the necessity of monitoring the hepatic function and conducting neurologic examination of the patients treated with amiodarone.
Aged ; Amiodarone/*adverse effects ; Anti-Arrhythmia Agents/*adverse effects ; Hepatitis, Toxic/*etiology ; Humans ; Liver Cirrhosis/chemically induced ; Male ; Polyneuropathies/*chemically induced

Pulmonary aspiration of gastric contents is one of the most frightening complications during anesthesia. Although pulmonary aspiration of gastric contents in general surgical patients is not common and resulting long-term morbidity and mortality are rare, severe hypoxemia and other sequelae of pulmonary aspiration continue to be reported. We report a case of massive aspiration of gastric contents during induction of general anesthesia, resulting in cardiac arrest due to severe pulmonary hypertension and myocardial infarction. Sustained cardiac arrest and shock that did not respond the conventional resuscitation was successfully treated using milrinone. The patient was discharged without complications in 20 days.
Anesthesia ; Anesthesia, General ; Anoxia ; Heart Arrest ; Humans ; Hypertension, Pulmonary ; Milrinone* ; Mortality ; Myocardial Infarction ; Respiratory Aspiration of Gastric Contents ; Resuscitation ; Shock ; Shock, Cardiogenic*

Epstein-Barr virus (EBV) is a rare causative agent of acute hepatitis during the course of infectious mononucleosis. EBV-associated hepatitis is usually mild and it resolves without serious complications. Clinically long-standing jaundice with a high bilirubin level (greater than 6.0 mg/dL and longer than 6 weeks) is extremely rare. We recently experienced a-16-yr-old man with long-standing severe jaundice (peak: 21 mg/dL, duration: 16weeks) that was caused by EBV in the absence of any other common features of infectious mononucleosis. EBV infection was demonstrated by serologic testing that showed positive IgM anti-EBV VCA (viral capsid antigen). We also confirmed that the liver was the primary site of EBV infection by in situ hybridization, which was performed on the liver tissues. The patient recovered completely without complications after 16 weeks with only supportive care. We report here on this case along with a literature review. EBV-associated hepatitis can occur with severe long-standing hyperbilirubinemia as an unusual manifestation.
Bilirubin ; Capsid ; Epstein-Barr Virus Infections ; Hepatitis ; Herpesvirus 4, Human ; Humans ; Hyperbilirubinemia ; Immunoglobulin M ; In Situ Hybridization ; Infectious Mononucleosis ; Jaundice ; Liver ; Serologic Tests ; Viruses