Stiff-person syndrome (SPS) is a rare CNS disease characterized by progressive fluctuating rigidity and superimposed muscle spasms. We report a woman who developed stiff-person syndrome in association with breast cancer. A 55-year-old woman had progressive rigidity and intermittent muscle spasms, which predominantly occurred in her right shoulder muscles. Her symptoms were aggravated by unexpected stimuli or emotional stress, but relieved during sleep. Needle electromyography showed continuous motor unit activities in affected muscles, which were completely abolished by general anesthesia. An Anti-GAD antibody test was negative. She also disclosed a subacute sensory neuronopathy, confirmed by nerve conduction study and sural nerve biopsy. Chest CT scan revealed an enlargement of the right axillary lymph node, which was proved to be a metastatic ductal carcinoma of the right breast. The authors report the first case of paraneoplastic stiff-person syndrome with sensory neuropathy of axonal type, which is associated with breast cancer.
Anesthesia, General ; Axons ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Central Nervous System Diseases ; Electromyography ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Muscles ; Needles ; Neural Conduction ; Shoulder ; Spasm ; Stiff-Person Syndrome* ; Stress, Psychological ; Sural Nerve ; Tomography, X-Ray Computed

Peripartum cardiomyopathy is a myocardial disease associated with pregnancy and leading to heart failure. A twenty-eight years old primipara was scheduled for a cesarean section due to a twin pregnancy. She had no previous cardiac or other systemic illness. But periodic episode of sudden hypertension, tachycardia, hypoxemia(PaO2/FiO2=58) and pulmonary edema were developed in the perioperative period. After being transferred to the intensive care unit, mechanical ventilation with positive end expiratory pressure was applied for six days and pulmonary infiltration subsided. However, two days after extubation, acute pulmonary edema redeveloped in both lung fields in spite of fluid restriction. In echocardiogram demonstrated global hypokinesia of the left ventricle with an ejection fraction of 31%. Dobutamine infusion was started and one day after infusion the pulmonary edema subsided. In conclusion echocardiogram would be helpful for diagnosis of peripartum cardiomyopathy and adequate cardiac support with assisted ventilation will improve prognosis.
Cardiomyopathies* ; Cesarean Section ; Diagnosis ; Dobutamine ; Edema ; Female ; Heart Failure ; Heart Ventricles ; Hypertension ; Hypokinesia ; Intensive Care Units ; Lung ; Perioperative Period ; Peripartum Period* ; Positive-Pressure Respiration ; Pregnancy ; Pregnancy, Twin ; Prognosis ; Pulmonary Edema* ; Respiration, Artificial ; Tachycardia ; Ventilation

In the present study, we made an attempt to compare polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) with PCR-direct sequence analysis for their accuracy and sensitivity in detecting resistance to rifampicin (RMP). A total of 32 clinical isolates of Mycobacterium tuberculosis including 22 resistant and 10 sensitive isolates, whose drug susceptibility have been tested by conventional proportion method, were analyzed by using PCR-SSCP and PCR-sequence analysis. Among 22 RMP resistant isolates, 16 isolates showed SSCP profiles different from that of a RMP sensitive control strain, M. tuberculosis H37Rv indicating the possible existence of a sequence alteration in this region of the rpoB gene, while 6 resistant isolates displayed SSCP profiles indistinguishable from the sensitive control strain. On the other hand, all of 10 RMP sensitive isolates showed SSCP profiles similar to that of the sensitive control strain. Therefore, overall agreement rste between conventional proportion method and PCR-SSCP reached 81%. Subsequently, all of 32 clinical isolates were subjected to sequence analysis. The results from the sequence analysis revealed that all of 22 resistant isolates indeed contain mutations in the stretch of 81 bp region of rpoB gene, while none of 10 sensitive isolates contain any sequence alterations. Therefore, this study suggests that PCR-sequence analysis works more efficiently and accurately than PCR-SSCP analysis for rapid screening of RMP-resistant M. tuberculosis clinical isolates.
Hand ; Mass Screening ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Polymorphism, Single-Stranded Conformational ; Rifampin* ; Sequence Analysis* ; Tuberculosis

No abstract available.
Chorea* ; Humans ; Moyamoya Disease*

PURPOSE: Transforming growth factor (TGF)-beta 1 stimulates collagen synthesis in human corpus cavernosum smooth cells (HCCSMC). We studied whether an antisense TGF-beta 1 oligodeoxynucleotide changed TGF-beta 1 mRNA expression and its related collagen synthesis. MATERIALS AND METHODS: The HCCSMC were cultured primarily from three impotent patients. Expression of TGF-beta 1 mRNA was induced by phorbol 12-myristate 13-acetate (PMA) 0.2 micro gram/ml in the presence or absence of antisense TGF-beta 1 oligodeoxynucleotide (5'-GGGCGGCATGGGGGA-3') 20 micro gram/ml. The effect of the antisense oligodeoxynucleotide on TGF-beta 1 mRNA and collagen I synthesis were measured by RT-PCR or Northern blot analysis. RESULTS: The expression of TGF-beta 1 mRNA in response to PMA was inhibited by treatment with the antisense oligodeoxynucleotide. Collagen I expression was also induced by PMA treatment, and the antisense oligodeoxynucleotide downregulated this expression. CONCLUSIONS: Antisense TGF-beta 1 oligodeoxynucleotide can suppress the expression of TGF-beta 1 and TGF-beta 1-induced collagen I synthesis in HCCSMC.
Blotting, Northern ; Collagen* ; Humans* ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; RNA, Messenger ; Transforming Growth Factor beta* ; Transforming Growth Factors

OBJECTIVE: The parturient with hypertensive disorders usually has multiple organ alterations, which may affect on the anesthetic care during cesarean delivery. The present study purposed to determine the optimal anesthesia method for the cesarean section of the patients with hypertensive disorders through clinical examination and to support adequate patient management. METHODS: We conducted a retrospective survey of medical records of the patients with hypertensive disorders of varying severity delivered by cesarean, between January 1999 and December 2003 at Gangnam CHA Hospital. According to anesthesia method, the patients were divided into the general anesthesia group and the epidural anesthesia group, and the clinical outcomes were compared statistically. RESULTS: Estimated intraoperative blood loss and the frequency of complications such as anemia and pulmonary edema were significantly lower in the epidural anesthesia group. However, there was no major complications with either general or epidural anesthesia CONCLUSION: Epidural anesthesia is considered allowable as the primary anesthesia method for the caesarean section of the parturient with hypertensive disorders.
Anemia ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Cesarean Section* ; Female ; Humans ; Medical Records ; Pregnancy ; Pregnancy* ; Pulmonary Edema ; Retrospective Studies

BACKGROUND: The differentiation of Mycobacterium tuberculosis (MTB) from nontuberculous mycobacteria (NTM) is of primary importance for infection control and choice of antimicrobial therapy. The diagnosis of diseases caused by NTM is difficult because NTM are prevalent in the environment and have fastidious properties. In this study, we evaluated the real-time PCR-based MTB/NTM detection kit for its usefulness in discrimination of MTB and NTM species. METHODS: A total of 155 sputum specimens whose AFB staining smear and culture were positive were used for this study. Among them, 59 and 96 samples had been identified as MTB and NTM, respectively. DNA obtained from sputum specimens was subjected to analysis with MolecuTech Real MTB-ID(R) (M&D, Korea) real-time PCR-based MTB/NTM detection kit. Subsequently, the results of MolecuTech Real MTB-ID(R) were compared with AFB staining smear and culture results. RESULTS: The positive rate of MolecuTech Real MTB-ID(R) to detect MTB and NTM was 98.3% (58/59) and 97.9 (94/96), respectively, using sputum specimens. CONCLUSION: For detection of MTB/NTM, the sensitivity and specificity of MolecuTech Real MTB-ID(R) were comparable to those of conventional methods. Therefore, this study suggests the usefulness of real-time PCR-based MolecuTech Real MTB-ID(R) for rapid detection of MTB/NTM from direct specimens.
Discrimination (Psychology) ; DNA ; Infection Control ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity ; Sputum

Ischiofemoral impingement (IFI) syndrome is an uncommon cause of gluteal and hip pain. We report on a case of a 20-year-old man who presented with chronic gluteal and hip pain with low back pain without a history of trauma or surgery. He was misdiagnosed with ankylosing spondylitis (AS) at another clinic. The patient was finally diagnosed with IFI syndrome according to pelvic magnetic resonance imaging findings at our hospital. After two weeks of medical and physical treatment, his pain showed gradual improvement. Because IFI syndrome is rarely reported in male patients, it might be misdiagnosed as AS. Therefore, IFI syndrome should be considered as a differential diagnosis of AS, particularly in young male patients with atypical pain characteristics.
Diagnosis, Differential* ; Hip ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Spondylitis, Ankylosing* ; Young Adult

Cryoglobulinemia is a rare medical condition defined by presence of cryoglobulins in serum and it may cause hyperviscosity syndrome or systemic vasculitis in variable organs including the skin, joints, liver, kidneys, lungs and nervous system. A vasculitic polyneuropathy or mononeuritis multiplex commonly occurs. However, central nervous system complications of cryoglobulinemia including stroke, encephalopathy and seizures are rarely reported. We represent a case of essential cryoglobulinemic vasculitis manifested as a sensorimotor polyneuropathy combined with an acute ischemic stroke attack.
Central Nervous System ; Cerebral Infarction* ; Cryoglobulinemia* ; Cryoglobulins ; Joints ; Kidney ; Liver ; Lung ; Mononeuropathies ; Nervous System ; Polyneuropathies* ; Seizures ; Skin ; Stroke ; Systemic Vasculitis ; Vasculitis

BACKGROUND: The hemodynamic status of critically ill patients is poorly predicted from clinical examination and chest x-ray findings, so equipments such as pulmonary artery catheter are needed for monitoring of hemodynamics. The authors undertook this study to evaluate physician's accuracy in predicting hemodynamic profiles, rates of therapeutic change resulting from catheterization and to compare the outcomes with or without therapeutic changes. METHODS: Pulmonary artery catheters were inserted in 19 critically ill patients. The physicians accuracy of predicting the hemodynamic profile, the rate of therapeutic changes by monitoring actual hemodynamic profiles were calculated and compared to the outcome between the patients with and without therapeutic change, RESULTS: Hemodynamic profiles were correctly predicted in 63% of all cases. Hemodynamic data from pulmonary artery catheter made the therapeutic plan changed in 53% of all cases. The cardiac index and left ventricular stroke work index were improved and the mortality rate was lower in patients with therapeutic changes, but there were no significant statistical differences between the patients with and without therapeutic changes. Complications occurred in 6 cases but had no effect on patient' s outcome. CONCLUSIONS: Hemodynamic data from a pulmonary artery catheter could lead to a more accurate diagnosis and therapeutic changes.
Catheterization ; Catheterization, Swan-Ganz* ; Catheters ; Critical Illness* ; Diagnosis ; Hemodynamics* ; Humans ; Mortality ; Pulmonary Artery* ; Stroke ; Thorax