The clinical diagnostic criteria of Parkinson's disease (PD) have limitations in detecting the disease at early stage and in differentiating heterogeneous clinical progression. The lack of reliable biomarker(s) for early diagnosis and prediction of prognosis is a major hurdle to achieve optimal clinical care of patients and efficient design of clinical trials for disease-modifying therapeutics. Numerous efforts to discover PD biomarkers in CSF were conducted. In this review, we describe the molecular pathogenesis of PD and discuss its implication to develop PD biomarkers in CSF. Next, we summarize the clinical utility of CSF biomarkers including alpha-synuclein for early and differential diagnosis, and prediction of PD progression. Given the heterogeneity in the clinical features of PD and none of the CSF biomarkers for an early diagnosis have been developed, research efforts to develop biomarkers to predict heterogeneous disease progression is on-going. Notably, a rapid cognitive decline followed by the development of dementia is a risk factor of poor prognosis in PD. In connection to this, CSF levels of Alzheimer's disease (AD) biomarkers have received considerable attention. However, we still need long-term longitudinal observational studies employing large cohorts to evaluate the clinical utility of CSF biomarkers reflecting Lewy body pathology and AD pathology in the brain. We believe that current research efforts including the Parkinson's Progression Markers Initiative will resolve the current needs of early diagnosis and/or prediction of disease progression using CSF biomarkers, and which will further accelerate the development of disease-modifying therapeutics and optimize the clinical management of PD patients.
alpha-Synuclein ; Alzheimer Disease ; Biomarkers* ; Brain ; Cerebrospinal Fluid* ; Cohort Studies ; Dementia ; Diagnosis, Differential ; Disease Progression ; Early Diagnosis ; Humans ; Lewy Bodies ; Parkinson Disease* ; Pathology ; Population Characteristics ; Prognosis ; Risk Factors

PURPOSE: To evaluate the relationship between foveal thickness and axial length and refractive power in healthy Koreans. METHODS: Ninety-eight healthy eyes were studied. The axial length was measured using A-scan (Paradigm mode p45, Kent, U.K.) and refractive power using automatic refractor Automatic refractor(HARK-599, Carl Zeiss, USA). The subjects were divided into 2 groups based on axial length (>or=25 mm and <25 mm) and refractive power (-6.0D). The foveal thickness was measured using OCT 3000 (Optical Coherence Tomography, Carl Zeiss, USA) and the statistical relationship between the 2 groups was analyzed by independent t-test. RESULTS: There was no statistically significant difference found in foveal thickness according to axial length between the two groups (p>0.05) nor according to refractive power (p>0.05). CONCLUSIONS: When eyes with pathologic myopia were excluded, The axial length and refractive power of the eyes had no relation to foveal thickness measured by OCT.
Myopia

A 61-year-old man was admitted to the emergency room complaining of a severe left exophthalmos caused by frontal and ethmoid sinus mucoceles that were visualized on a brain computerized tomogram. In addition, he had coexisting ankylosing spondylitis with a 20 year duration that resulted in total fixation of the cervical spine and progressive thoracic kyphosis. An unruptured anterior communicating artery aneurysm was found incidentally on the cerebral angiogram. We report that the anesthetic management for endoscopic sinus surgery of a frontal sinus mucocele in a patient with coexisting severe cervical spine ankylosing spondylitis and an unruptured cerebral aneurysm requires a detailed preoperative assessment of the airway, cardiac, pulmonary, and neurologic system. This case highlights the need for careful measures to avoid rupturing the cerebral aneurysm by the increased blood pressure induced by endotracheal intubation and the infiltration of an epinephrine-containing local anesthetic.
Blood Pressure ; Brain ; Emergencies ; Ethmoid Sinus ; Exophthalmos ; Frontal Sinus ; Humans ; Intracranial Aneurysm ; Intubation, Intratracheal ; Kyphosis ; Middle Aged ; Mucocele ; Spine ; Spondylitis, Ankylosing

PURPOSE: Differential diagnosis of acute abdominal pain of the childbearing age woman is a difficult challenge to the emergency physician. Clinical scoring systems for pelvic inflammatory disease (PID) and acute appendicitis have already been introduced. We want to validate these scoring systems externally. METHODS: This study was conducted at a single urban teaching hospital emergency department from May 2011 to September 2013. Retrospective analysis of a prospectively collected registry for reproductive-aged women was performed. RESULTS: A total of 1432 patients were registered. Among them, 322 patients diagnosed as PID (177 patients) or acute appendicitis (145 patients) were finally analyzed in this study. Among the PID and acute appendicitis scored, lower and higher cut-off points were 3 and 8 for PID risk score, and 6 and 10 for appendicitis risk score. PID risk score of PID patients was 7.0 (+/-1.9), acute appendicitis patients was 4.3 (+/-2.1), and other patients was 4.0 (+/-2.2) (p<0.001). Appendicitis risk score of PID patients was 5.7 (+/-1.9), acute appendicitis patients was 9.0 (+/-2.1), and other patients was 5 (+/-1.6) (p<0.001). The areas under the receiver operating characteristic curves were 0,832 and 0,950 for diagnosis of PID with PID risk score and acute appendicitis with appendicitis risk score, respectively. CONCLUSION: These scoring systems have appropriate diagnostic power for diagnosis of PID and acute appendicitis.
Abdominal Pain* ; Appendicitis* ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital* ; Female ; Hospitals, Teaching ; Humans ; Pelvic Inflammatory Disease* ; Prospective Studies ; Retrospective Studies ; ROC Curve

PURPOSE: To find out the consequences of the surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with Mersilene tape augmentation. MATERIALS AND METHODS: We chose 26 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through February 2001 to March 2003 and took modified Phemister surgery with Mersilene tape augmentation. Patients with clavicle fracture were excluded. Evaluation of the surgical results was done with the condition or pain, function, range of motion by using Imatani evaluation system, and preoperative, postoperative and last follow up radiographs. RESULTS: Most of the cases showed satisfactory result. Clinical evaluations were 16 excellent (62%), 10 good (38%), radiological evaluations were 14 excellent (54%), 10 good (38%), 2 fair (8%), and no poor group. On the final follow up six cases showed vertical translation, but none had clinical symptoms. Seven cases showed a little inflammation at where pin were inserted, but after the removal of the pin, the inflammation was gone. CONCLUSION: The modified Phemister surgery for acromioclavicle dislocation is simple, but we can obtain strong fixation, and there is no burden of the removal of the metal plate, or complication of re- dislocation after the removal of the pin, so it is thought as a very effective surgery.
Acromioclavicular Joint* ; Clavicle ; Dislocations* ; Follow-Up Studies ; Humans ; Inflammation ; Range of Motion, Articular

Camurati-Engelmann disease (CED) is an autosomal dominant progressive diaphyseal dysplasia caused by mutations in the transforming growth factor-beta1 (TGFB1) gene. We report the first Korean family with an affected mother and son who were diagnosed with CED. The proband is a 19-yr-old male with a history of abnormal gait since the age of 2. He also suffered from proximal muscle weakness, pain in the extremities, and easy fatigability. Skeletal radiographs of the long bones revealed cortical, periosteal, and endosteal thickenings, predominantly affecting the diaphyses of the upper and lower extremities. No other bony abnormalities were noted in the skull and spine and no remarkable findings were seen on laboratory tests. The patient's mother had a long-standing history of mild limb pain. Under the impression of CED on radiographic studies, we performed mutation analysis. A heterozygous G to A transition at cDNA position +653 in exon 4 of the TGFB1 gene (R218H) was detected in the patient and his mother.
Adult ; Amino Acid Substitution ; Camurati-Engelmann Syndrome/*diagnosis/radiography ; DNA Mutational Analysis ; Diaphyses/radiography ; Heterozygote ; Humans ; Korea ; Male ; Muscle Weakness/radiography ; Pedigree ; Transforming Growth Factor beta1/*genetics

PURPOSE: We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels. MATERIALS AND METHODS: The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012. RESULTS: Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7+/-33.1 ug/L and 72.2+/-24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1+/-31.8 ug/L in cardia cancer group (10 cases) and 121.8+/-32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7+/-29.6 ug/dl in early gastric cancer (33) and 66.9+/-17.8 ug/dl in advanced gastric cancer (41) (P=0.064). CONCLUSIONS: The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.
Cardia ; Gastrectomy ; Humans ; Male ; Selenium ; Stomach Neoplasms ; Zinc

PURPOSE: We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels. MATERIALS AND METHODS: The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012. RESULTS: Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7+/-33.1 ug/L and 72.2+/-24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1+/-31.8 ug/L in cardia cancer group (10 cases) and 121.8+/-32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7+/-29.6 ug/dl in early gastric cancer (33) and 66.9+/-17.8 ug/dl in advanced gastric cancer (41) (P=0.064). CONCLUSIONS: The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.
Cardia ; Gastrectomy ; Humans ; Male ; Selenium ; Stomach Neoplasms ; Zinc

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.
Adult ; Alcoholic Intoxication/*complications ; Ascorbic Acid/blood/therapeutic use ; Ascorbic Acid Deficiency/*complications/drug therapy/epidemiology ; Emergency Service, Hospital ; Female ; *Homeless Persons ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Vitamin B Complex/blood

The corpus callosum consists of white fibers connecting the cerebral hemispheres. Agenesis of the corpus callosum is an uncommon congenital anomaly which is easily diagnosed in the postnatal period by ultrasound and computed tomographic scan or MRI, but its prenatal sonographic diagnosis is difficult because of fetal head positioning and limiting trans-axial scans. We experienced a case of agenesis of the corpus callusum with chromosomal anomaly. The prenatal sonographic findings are ventricular abnormalities that demonstrated dilatation of lateral ventricles and disproportionate enlargement of the occipital horns, which were suggestive findings for the corpus callosal agenesis. We could confim the diagnosis of the corpus callosal agenesis with chromosome anomaly by postnatal MRI and chromosome analysis.
Agenesis of Corpus Callosum* ; Animals ; Cerebrum ; Corpus Callosum ; Diagnosis ; Dilatation ; Head ; Horns ; Lateral Ventricles ; Magnetic Resonance Imaging ; Ultrasonography