A 29 year old man without any noticeable past or familial history presented with left ACA and MCA territorial hemorrhagic infarction after consuming an overdose of disulfiram in a drunken state. This hemorrhagic infarction was thought to be caused by cardiac embolism, which developed following cardiac arrhythmia and cardiac injury induced by O form acceptor reductase associated with disulfiram poisoning. (J Korean Neurol Assoc 19(3):294~297, 2001)
Adult ; Arrhythmias, Cardiac ; Cerebral Infarction* ; Disulfiram* ; Embolism ; Humans ; Infarction ; Oxidoreductases ; Poisoning*

BACKGROUND: This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. MATERIALS AND METHODS: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. RESULTS: The significant electrodecremental response of RNST were noted in orbicularis oculi (58.9%), nasalis (51.3%), flexor carpi ulnaris (42%), anconeus (41%) and abductor digiti quinti muscles (27%). Among the 3 muscles of upper extremity (abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles (p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. CONCLUSION: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.
Classification ; Facial Muscles ; Humans ; Muscles* ; Myasthenia Gravis* ; Upper Extremity

The hyperparathyroidism which causes renal osteodystrophy is a common complication in patients with end stage renal diseases. It is usually normalized after successful renal transplantation, but it remains in some renal transplant recipients. It is not well known whether hyperparathyroidism decreases bone mineral density in renal allograft recipients or not. To evaluate the incidence and predictive marker for hyperparathyroidism in renal allograft recipients and to describe the impact of hyperparathyroidism on the bone mineral density, we measured intact parathyroid hormone(iPTH) in 193 renal allograft recipients with stable renal and hepatic function. The mean age of patients was 42+/-12(13-76) years old and male female ratio was 1.9. The patients were on pre-transplant dialysis for 14.4+/-15.6(0-130) months and were followed up for 43.8+/-35.7(2-204) months after transplantation. Of the total 193 patients, 13 patients(6.7%) had high iPTH level. All patients showed normal serum calcium and phosphorous levels. iPTH levels were positively correlated to pre- and post-transplant serum alkaline phosphatase levels(vs. pre-transplant r=0.32, P<0.001, vs post- transplant r=0.63, P<0.001). There was no difference in pre- and post-transplant serum calcium, phosphorus, post-transplant serum creatinine and hemoglobin levels between the patients. There were no statistical differences in age, sex, duration of pre-transplant dialysis, duration of post-transplant follow-up, number of transplantation, donor type, primary renal disease and episodes of acute rejection. Of the total 193 patients, bone mineral density was studied in 37 patients. Bone mineral densities did not correlated to iPTH levels. In conclusion, the incidence of hyperparathyroidism in renal allograft recipients with stable renal function was 6.7%. Pre- and post-transplant serum alkaline phosphatase levels might be used as a useful marker for hyperparathyroidism. Serum iPTH level was not correlated to bone mineral density.
Alkaline Phosphatase ; Allografts* ; Bone Density ; Calcium ; Creatinine ; Dialysis ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism* ; Incidence* ; Kidney Transplantation ; Male ; Phosphorus ; Renal Osteodystrophy ; Tissue Donors ; Transplantation

No abstract available.