Limb-shaking transient ischemic attack is a rare disease, associated with the steno-occlusion of the internal carotid artery. It is caused by hemodynamic dysfunction in the anterior circulation. It is difficult to observe patients directly in clinical settings since they visit the hospital after symptoms have subsided which usually last less than 5 minutes. Here we report a atient who developed right arm dominant myoclonus related to left internal carotid artery occlusion along with a recorded video.

Limb-shaking transient ischemic attack is a rare disease, associated with the steno-occlusion of the internal carotid artery. It is caused by hemodynamic dysfunction in the anterior circulation. It is difficult to observe patients directly in clinical settings since they visit the hospital after symptoms have subsided which usually last less than 5 minutes. Here we report a atient who developed right arm dominant myoclonus related to left internal carotid artery occlusion along with a recorded video.

PURPOSE: While performing clean intermittent catheterization(CIC), atraumatic and non-infecting techniques are important in preventing long-term complications secondary to CIC. The aim of this study is to characterize several essential technical aspects of CIC in patients with neurologically stable spinal cord injury or diseases(SCI/D). MATERIALS AND METHODS: Between July 2002 and March 2003, a prospective questionnaire survey was undertaken in 106 neurologically stable SCI/D patients who were performing CIC as primary bladder emptying methods. Structured questionnaire was administered with the interview. Questionnaire items included key technical CIC steps and related questions. RESULTS: Mean age of the patients(74 males and 32 females) were 35.9(+/-1.3, SE) years and the duration of CIC was 17.3(+/-2.3) months. Levels of SCI/D were: cervical in 45 patients(42.4%), followed by thoracic in 43(40.6%), lumbar in 16(15.1%), and sacral in 2(1.9%). Omitting hand washing before CIC was found in 16 patients(15.1%), meatal cleansing before CIC in 13(12.3%), using lubricants in 12(11.3%), and performing CIC as a timed basis in 36(34.0%). The most preferred posture to perform CIC were: sitting(63.0%), followed by lying(19.1%) and standing(14.6%) in men, while sitting(45.6%), followed by the squatting(33.3%) and lying(15.8%) in women. Majority of the patients performed CIC five times a day with spending about ten minutes for each CIC. Omitting key elements were not significantly associated with the sex, age, level of SCI/D, duration of CIC, level of education, socioeconomic status. However, omitting meatal cleaning before CIC were significantly associated with the patients with shorter duration of performing CIC, lower educational level, and lower socioeconomic status(p<0.05). 57.6% of the patients were satisfied with the current CIC methods. CONCLUSION: Our results showed that some patients do omit key elements of the CIC steps. These elements should be emphasized during the initial CIC education and also must be screened during long-term followup in the SCI/D patients performing CIC.
Catheterization ; Education ; Female ; Follow-Up Studies ; Hand Disinfection ; Humans ; Intermittent Urethral Catheterization* ; Lubricants ; Male ; Posture ; Prospective Studies ; Surveys and Questionnaires ; Social Class ; Spinal Cord Diseases* ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic

OBJECTIVE: The purpose was to investigate the characteristics of oropharyngeal dysphagia and videofluoroscopic study (VFSS) findings in esophageal diseases. METHOD: We retrospectively reviewed the clinical characteristics and VFSS findings in thirteen patients with esophageal cancer and stricture. Videofluoroscopic parameters of oral, pharyngeal, and esophageal phases were measured. Patients were divided into three groups according to their diseases: Group A, esophageal cancer with esophagectomy (5 patients); Group B, esophageal cancer with non-operative treatment (3 patients); and Group C, esophageal stricture with surgical treatment (5 patients). RESULTS: Group A had vocal cord palsy (VCP) after esophagectomy, and all patients showed poor laryngeal closure and aspiration during swallowing. Group B received radiation therapy prior to VFSS and showed poor laryngeal closure and high pharyngeal residue with aspiration during and after swallowing. Group C received esophagectomy with anastomosis of lower gastrointestinal tract (stomach, jejunum, colon). Most had VCP and showed high pharyngeal residue, stricture of upper esophageal sphincter, and poor oral control with aspiration during and after swallowing. CONCLUSION: Characteristics of dysphagia on VFSS were poor laryngeal closure in operated esophageal cancer patients. In patients of non-operated esophageal cancer and esophageal stricture, high pharyngeal residue and poor laryngeal closure were characterized.
Constriction, Pathologic ; Deglutition ; Deglutition Disorders* ; Esophageal Diseases* ; Esophageal Neoplasms ; Esophageal Sphincter, Upper ; Esophageal Stenosis ; Esophagectomy ; Esophagus ; Humans ; Jejunum ; Lower Gastrointestinal Tract ; Oropharynx ; Retrospective Studies ; Vocal Cord Paralysis

A 55-year-old man with massive pulmonary thromboembolism underwent thrombolysis, pulmonary artery embolectomy and tricuspid annuloplasty. Nine months later, a mobile echogenic intra-cardiac mass was found in the tricuspid valve. Because the patient had undergone annuloplasty, thrombosis was suspected as the most likely diagnosis and thrombolytic therapy was instituted. However, the size of the cardiac mass did not change and after surgical excision the mass was found to be a myxoma. Cardiac valvular tumors are uncommon and when they occur they are usually slow growing fibroelastomas. In this case, the rapid growing cardiac myxoma on the tricuspid valve was found after the occurrence of pulmonary thromboembolism. To our knowledge, this is first reported case of tricuspid valve myxoma in Korea.
Embolectomy ; Humans ; Korea ; Middle Aged ; Myxoma ; Pulmonary Artery ; Pulmonary Embolism ; Thrombolytic Therapy ; Thrombosis ; Tricuspid Valve

Multiple mycotic pseudoaneurysms that develop after aortic surgery are a rare infectious complication. The clinical course of this disease is severe and associated with a high mortality. Few published cases have described mycotic pseudoaneurysms that are localized mainly in the brain, heart, and aorta. In this case, a 33-year-old woman was admitted with abdominal pain and mild fever after graft surgery for a ruptured thoracic aorta that occurred following a vehicle accident. Thoracoabdominal computed tomography (CT), angiography, and transesophageal echocardiography (TEE) demonstrated multiple pseudoaneurysms and thromboembolic obstructions in the thoracic aorta and its branches. She was treated with anticoagulation, coil embolization, and surgical resection. Microscopically, a resected pseudoaneurysm showed the characteristic features of fungal colonies with thrombi. This patient has been well for 2 months after removing the pseudoaneurysms and treatment with systemic antifungal agents.
Abdominal Pain ; Adult ; Aneurysm, False ; Angiography ; Antifungal Agents ; Aorta ; Aorta, Thoracic ; Brain ; Echocardiography, Transesophageal ; Female ; Fever ; Heart ; Humans ; Thromboembolism ; Transplants

There are severe soft tissue defects associated with intercalary segmental or distal loss of bone in the crushing injury of the hand by high-energy machine such as presser, electrical saw, and agricultural machine. Bone grafting to restore the skeletal scaffold is essential for reconstruction of the soft tissue and preservation of the digit function. However, non-vascularized free bone grafts are not desirable, because recipient sites often have a poorly vascularized bed. We described 12 cases, which were reconstructed by the lateral arm osteofasciocutaneous or osteofascial free flap from 1997 to 2001. The bone was harvested from the distal humeral bone as an osteofasciocutaneous lateral arm flap that has constant osseous branches from the main pedicle of the posterior radial collateral artery along the lateral intermuscular septum. Lateral arm osteofasciocutaneous flap is able to provide well vascularized bone and soft tissue for hand reconstruction. All flaps survived and had acceptable shape and function without bone resorption. We consider that lateral arm osteofasciocutaneous flap is a useful method for reconstruction of the composite tissue defect containing the bone in one-stage operation of the hand.
Arm* ; Arteries ; Bone Resorption ; Bone Transplantation ; Free Tissue Flaps* ; Hand* ; Transplants

Reconstruction of a finger-pulp defect is one of the most difficult procedures. The reasons are that the identical donor tissue is not easy to obtain and the reducing the donor site morbidity is not easy to achieve. Particularly, reconstruction of multiple digit pulp defect is more difficult. We propose toe partial pulp free flaps for the replacement of defects of multiple fingertip. It can provide identical color matching to donor defect, and cut down the morbidity of donor site. The 33 digits of 15 patients were treated with this method. The donor sites were medial aspect of the second toe or third toe and lateral aspect of big toe. The neurovascular pedicles were composed of medial plantar digital artery, medial plantar digital nerve, and superficial plantar vein of the second toe, third toe or big toe. All flaps were survived. The average of static two-point discrimination was 5.9 mm. Primary closure of donor sites was possible in all cases. Toe partial pulp free flaps has many advantages in multiple digit reconstruction. It can provide excellent color and texture matching, excellent sensory recovery. It avoids long term immobilization. Vascular anatomy was so consistent that vessels were easily dissected. Primary closure of donor site was possible. However, there were some restrictions. The flap could not be applied to a large defect, and to patients with vascular disease and old age. It also required skillful technique in anastomosis of pedicle. In conclusion, we consider that toe partial-pulp free flaps are useful method to reconstruct the defects of multiple fingertips.
Arteries ; Discrimination (Psychology) ; Free Tissue Flaps* ; Humans ; Immobilization ; Tissue Donors ; Toes* ; Vascular Diseases ; Veins

PURPOSE: The germline, or somatic, inactivation of tumor suppressor genes, through point mutation, or deletion, plays an important role in carcinogenesis. Several gene alterations, such as adenomatous polyposis coli (APC), deleted in colorectal cancer (DCC) and p53, have been detected in the development of colorectal cancer. Within these genes, a loss of heterozygosity (LOH) at the DCC gene locus was frequently associated with colorectal tumors, and the LOH of the DCC gene, and the expression of the DCC protein, might be related to malignant formation and metastasis. The aim of this study was to determine the DCC LOH and the expression of DCC protein in colorectal cancers, and evaluate their prognostic value and relationship with the clinicopathological data. MTHODE: Fifty colorectal cancer tissues were obtained from resected specimens. Using formalin-fixed paraffin- embedded sections as a source of DNA, we examined the DCC protein in the tissue through immunohistochemical stainings and immunoblotting analysis, the DCC LOH through a polymerase chain reaction (PCR) and single strand conformation polymorphism (SSCP). RESULTS: DCC LOH was observed in 24 of the 50 patients (48.0%). The expression of the DCC protein was decreased in the cancer tissue (62.3 23.6%) compared with the adjacent normal mucosa inform the immunoblotting analysis. A decreased DCC protein expression was also observed from the immunohistochemistry, which coincided with the immunoblotting analysis. However, both the DCC LOH and the decreased DCC protein were not related to the clinical and pathological parameters, such as location of tumor, tumor size, histological type and the venous, and lymphatic invasions. There were significant correlations between the DCC protein expression and tumor progression, and hematogenous metastasis (P<.05). CONCLUSIONS: A decreased expression of the DCC protein was noted in human colorectal cancers, and there was a significant relationship between the expression of the DCC protein and distant metastasis, but there was no correlation between the DCC LOH and distant metastasis. These results suggest that the expression of the DCC protein might be related to tumor progression and metastatic potential, and the DCC protein immunoreactivity may be a useful prognostic factor in patients with colorectal cancers.
Adenomatous Polyposis Coli ; Carcinogenesis ; Colorectal Neoplasms* ; DNA ; Genes, DCC* ; Genes, Tumor Suppressor ; Genes, vif ; Humans ; Immunoblotting ; Immunohistochemistry ; Loss of Heterozygosity ; Mucous Membrane ; Neoplasm Metastasis ; Point Mutation ; Polymerase Chain Reaction

OBJECTIVE: To investigate the effects of full-time integrated self upper-extremity training program (FISUTP) on functional recovery and length of stay in stroke patients. METHOD: Fifty-nine patients were enrolled and divided into FISUTP and control groups. The FISUTP group (n=29) underwent conventional physical and occupational therapy and FISUTP daily during their hospital stay, whereas control group (n=30) received only daily conventional therapy (physical and occupational therapy). The outcome was measured by Korean version of modified Barthel index (K-MBI), Fugl-Meyer motor assessment (FMA), and length of stay (LOS). RESULTS: FISUTP group showed significantly shorter LOS and higher improvement in functional status changes (K-MBI changes and FMA changes) during hospital day than control group (p<0.05). CONCLUSION: The results showed FISUTP is an effective treatment for the improvement of functional outcome and reduction of hospital stay in stroke patients.
Humans ; Length of Stay ; Occupational Therapy ; Stroke ; Upper Extremity